This paper summarizes and analyzes the regression of the mucosa of the operative cavity after nasal endoscopic surgery in 2000 patients with chronic sinusitis and nasal polyps treated with two different anesthetic methods in our department, so as to explore the appropriate anesthetic methods for nasal endoscopic surgery in patients with different types of chronic sinusitis and nasal polyps. Yu Guojang, Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University
1 Data and methods
1.1 General data. 2000 patients with chronic sinusitis and nasal polyps undergoing nasal endoscopic surgery from January 1996 to October 2008, 1251 males and 749 females, aged 14-71 years, including 1601 patients (80%) aged 20-50 years. According to the 1997 Haikou standard clinical staging, there were 180 cases of type I stage 1, 420 cases of type I stage 2, 304 cases of type I stage 3; 302 cases of type II stage 1, 256 cases of type II stage 2, 242 cases of type II stage 3; and 296 cases of type III.
1.2 Surgical methods.
1.2.1 Local anesthesia. Patients were placed supine with head elevated at 30°, routinely disinfected and toweled, and given 1% bupivacaine 20 ml plus 1‰ epinephrine 8 ml cotton under nasal endoscopy, and astringent anesthesia in the middle and common nasal passages. The surgery was guided according to the extent and location indicated by the patient’s sinus CT film. The surgery was performed in the through-Messerklinger procedure, with excision of the hooks, removal of polyps, opening of the anterior and posterior groups of septal sinuses, maxillary sinuses, frontal sinuses and pterygoid sinuses according to different conditions, correction of anatomical variants: e.g. partial excision of the vesicular middle and inferior turbinates, correction of the deviated nasal septum, etc. After surgery, the surgical cavity was filled with gelatin sponge or Vaseline oil gauze.
1.2.2 General anesthesia. General anesthesia was induced with 2-3 µg/kg of fentanyl, 1.5-2.0 g/kg of isoproterenol and 0.5 mg/kg of atracurium, rapid endotracheal intubation, and mechanical ventilation according to the Drager anesthesia ventilator to regulate the tidal volume. After the general anesthesia took effect, the patient was placed supine with head elevated at 30°, and 20 ml of saline plus 8 ml of 1‰ epinephrine was administered to anaesthetize the olfactory fissure, middle nasal tract and common nasal tract, and the rest of the operation was performed in the same way as local anesthesia.
1.3 Postoperative treatment and observation contents. The nasal cavity was filled with a hemostatic sponge for obvious bleeding, and the rest of the nasal cavity was filled with Vaseline oil gauze and treated with rehydration and antibiotics. 48 h after surgery, the nasal gauze was withdrawn and the nasal cavity was rinsed with 250 ml of saline plus 240,000 units of gentamicin every day until discharge. Nasal endoscopy was performed 1, 2, 3, 4 and 6 weeks after surgery to observe the condition of the operative cavity, and the average time of mucosal epithelialization in the operative cavity was recorded in patients with chronic sinusitis and nasal polyps with different lesions under two different anesthetic methods.
The criteria for epithelialization were: thin and smooth mucosa, tightly connected to the bone wall, the bone wall showed clear elevation of each ministry under the tight coverage of mucosa, and the sinus opening was open.
2 Results
The mean time of postoperative cavity epithelialization in type I and type II stage 1 patients was not statistically significantly different between the general and local anesthesia groups (P>0.05); the mean time of postoperative cavity mucosal epithelialization in type II stage 2, type II stage 3 and type III patients was significantly better in the general anesthesia group. The mean time of postoperative mucosal epithelialization was significantly better in the general anesthesia group than in the local anesthesia group, and the difference was statistically significant (P<0.05, Table 1).
3 DISCUSSION
Nasal endoscopic surgery requires high requirements for surgical anesthesia because most of the operated organs are deep, with fine and complex anatomy and rich neurovascularity. Not only is it necessary to achieve a sufficient depth of anesthesia to reduce the patient’s pain during surgery and to make the patient actively cooperate with the surgery, but it is also required to reduce reactive blood pressure elevation and nasal bleeding. At present, there are two types of anesthesia available to us: local anesthesia and general anesthesia. Local anesthesia has the advantages of simplicity, ease of use and economy, but the analgesic effect is significantly worse than that of general anesthesia; operating under general anesthesia, the patient can better cooperate with the operation, especially for patients with extensive lesions, re-operation and poor tolerance.
It is more suitable for patients with extensive lesions, reoperation and poor tolerance. Controlled hypotension can also be applied in general anesthesia to reduce intraoperative bleeding, maintain a clear operative field, and improve the surgical effect, which directly affects the recovery of the postoperative cavity mucosa. In this paper, we summarized 2000 patients who underwent nasal endoscopy in our department, and found that the mean time of postoperative mucosal epithelialization was not significantly different between type I and type II stage 1 patients who underwent nasal endoscopy under two types of anesthesia (P>0.05), while the mean time of postoperative mucosal epithelialization in the postoperative cavity of type II stage 2, type II stage 3 and type III patients was significantly better in the general anesthesia group than in the local anesthesia group, and the difference was statistically The difference was statistically significant. Analyzing the reasons, for patients with type II stage 2, II stage 3, and III, the lesions are heavier and more extensive, especially those who encounter recurrent sinusitis, unclear anatomical structures, and scar tissue hyperplasia, the surgery is difficult and there is more intraoperative bleeding. Under general anesthesia, we can achieve smooth anesthesia, good analgesia, clear surgical field, and no pain for the patient, and we can use controlled hypotension to reduce intraoperative bleeding. The postoperative recovery is improved accordingly. For patients with type I and type II stage 1 lesions, which are relatively mild, both anesthesia methods can achieve good surgical results, so there is no significant difference in postoperative recovery.