Browsing by Author "Cattano, Davide (8545515300)"

a sound anesthesiologist-surgeon collaboration is crucial for the success of functional endoscopic sinus surgery (Fess). the aim of this narrative review was to describe if and how anesthetic choice can decrease bleeding and improve visibility in the surgical field (VSF) and thus contribute to successful FESS. A literature search was conducted on evidence-based practices published from 2011 to 2021 describing perioperative care, intravenous/inhalation anesthetics, and operative approaches for Fess and their effects on blood loss and vsF. With regards to preoperative care and operative approaches, best clinical practices include topical vasoconstrictors at the time of surgery, medical management (steroids) preoperatively, and patient positioning, as well as anesthetic techniques including controlled hypotension, ventilation settings, and anesthetics choices. Four out of five meta-analyses and six out of 11 randomized controlled trials favored total intravenous anesthesia (tiva) over inhalation anesthesia (ia) for improved vsF. the effects on vsF were more dependent on adjunct medications used (remifentanil, alpha-2 agonists, etc.), rather than the choice of anesthetic technique (i.e., tiva vs. ia). the current literature is inconclusive regarding the impact of anesthetic choice on vsF during Fess. We recommend that anesthesiologists use the anesthetic technique with which they are most comfortable to facilitate efficiency, recovery, cost, and collaboration with the perioperative team. Future studies should be designed to consider disease severity, the method for measuring blood loss, and a standardized vsF score. studies should also investigate the long-term effects of tiva- and ia- induced hypotension. (Cite this article as: stamenkovic DM, ahmad Jg, corso rM, Unic stojanovic D, radabaugh JP, citardi MJ, et al. Perioperative management and surgical field optimization in functional endoscopic sinus surgery. Minerva Anestesiol 2023;89:316-30. DOI: 10.23736/S0375-9393.22.16887-2) © 2022 eDiZioni Minerva MeDica.

Preoperative anxiety can influence the intensity of postoperative pain and anesthesia and analgesia requirement. In certain types of surgery, anxiety may even increase postoperative morbidity and mortality. The goal of this narrative review is to remind anesthesiologists that anxiety measurement using specific tools can be done in clinical practice, to present the implications of preoperative anxiety on postoperative patient recovery, and to acknowledge the importance of a dedicated anesthesia plan in the management of anxious adult patients. Preoperative assessment performed several weeks before surgery in an outpatient clinic is a reasonable option to give information about surgery, anesthesia and postoperative pain. This is the time to assess patient preoperative anxiety by using VAS-A. If high anxiety level is detected early, the patient can be referred to a psychologist for preoperative preparation. This is consistent with the guidelines for enhanced recovery after surgeries, which underline the importance of patient-doctor discussion about hospitalization and perioperative care. Patients with preoperative anxiety could benefit from multimodal analgesia, including non-pharmacological methods, such as cognitive therapy and music therapy and relaxation. The authors' opinion is that greater education about preoperative anxiety consequences in the surgical community is needed. A systemized approach and guidelines about the management of preoperative anxiety should be followed. © 2018 EDIZIONIMINERVAMEDICA.