Browsing by Author "Unic Stojanovic, Dragana (55376745500)"

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.

Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers (HCWs) have been at high risk of infection. This study investigated clinical and treatment characteristics of infected HCWs at a cardiovascular hospital. Methods: This retrospective study was conducted at a tertiary cardiovascular hospital and included HCWs with confirmed COVID-19. Subjects completed a questionnaire on health status, symptoms, admission to hospital and treatment. Vaccination status against tuberculosis, hepatitis B and seasonal influenza was assessed. Pneumonia was defined as ground glass opacifications (GGOs) and consolidations on computed tomography (CT). Results: This study included 107 HCWs with confirmed COVID-19, representing 15% of all HCWs (n = 726) at the study hospital. Most of the confirmed cases worked in the cardiac surgery department, the anaesthesiology and intensive care medicine department, and the postoperative ward [74/107 (69%)]. A substantial number of infected HCWs were asymptomatic [31 (28.9%)], and 38 (35.5%) were admitted to hospital. The mean ± standard deviation length of hospital stay was 8.1 ± 5.6 days. Seventy-five of 107 (70.1%) confirmed cases had been vaccinated against seasonal influenza. Pneumonia with GGOs and consolidations on CT occurred in 25 of 107 (23.4%) HCWs, with 14 (13.1%) cases of bilateral involvement. On multivariate logistic regression analysis including characteristics known to be associated with poorer outcomes in COVID-19 (i.e. obesity, diabetes mellitus, coronary artery disease, cerebrovascular disease, current smoking, heart failure, seasonal influenza immunization), only seasonal influenza immunization remained an independent predictor of the occurrence of bilateral pneumonia (odds ratio 0.207, 95% confidence interval 0.050–0.847; P = 0.029). Conclusions: The association found between seasonal influenza immunization and less-aggressive COVID-19 pneumonia may support the implementation of preventive measures to reduce the global burden of COVID-19. © 2020 The Authors