Chronic sinusitis is a common disease, and with the development of endoscopic surgery in China, the treatment effect of nasal polyps in chronic sinusitis has been greatly improved, but there are still a considerable number of patients with recurrence or various complications after surgery due to various reasons. This topic will discuss the experience of perioperative management in nasal endoscopic surgery in order to improve the safety of surgery and reduce complications. 1.1 Preoperative examination All patients undergo routine ENT examination and CT coronal and/or axial scans of the sinuses before surgery. Detailed medical history is taken, especially for common underlying diseases, and previous and current treatment is understood. Complete preoperative relevant ancillary examinations. Communicate well with the patient to understand his or her psychological state and try to make the patient have reasonable expectations about the surgery. 1.2 Pre-operative medication For patients with combined underlying diseases, consult with a specialist before surgery to develop a relevant treatment plan. In hypertensive patients, blood pressure was controlled below 160/90 mmHg, and in diabetic patients, fasting blood glucose was controlled below 8 mmol/L, which did not need to be forced to be controlled in the normal range [2]. All patients were given daily nasal spray with budesonide for 1-3 weeks before surgery and routine macrolide antibiotics for 3-7 days to reduce local inflammation and decrease intraoperative bleeding. 1.3 Surgical method Surgical treatment should follow the principle of restoring and reestablishing normal sinus drainage and removing lesions and preserving the normal mucosa and structures of the nasal cavity and sinuses in a unified manner. Preoperative CT results of the sinuses should be carefully read and analyzed to fully understand the scope of sinus lesions and osteophytes of the patient, and the scope and degree of sinus lesions that need to be treated by surgery should be correctly judged and evaluated. If the symptoms and signs improve with systematic medication before surgery, sinus CT should be performed again after treatment, which can reflect the extent of sinus lesions requiring surgery more realistically and combine with what is seen in the nasal endoscopy to design the surgery correctly. Nasal endoscopy is performed with 2% bupivacaine plus epinephrine cotton nasal surface anesthesia, followed by excision of multiple polyps in the nasal cavity and some polypoid lesions in the middle turbinate using an electric suction cutter to better identify the anatomical landmarks of the nasal cavity [3]. The Messerklinger technique was used to remove the hooked process, and the anterior and posterior groups of septal sinus, frontal sinus, pterygoid sinus and enlarged natural opening of maxillary sinus were opened according to the patient’s specific lesion. If the septum is deviated, especially the posterior high deviation affects the drainage of the sinus orifice and nasal tract complex, septal correction should be performed at the same time, and if the middle turbinate is hypertrophic or polypoid and vesicular middle turbinate, middle turbinate shaping should be performed, and if the anterior or inferior margin is too long, the anterior inferior margin should be partially excised. After the operation, the surgical cavity was filled with small gauze containing epinephrine saline for a moment, and those without obvious bleeding were filled with absorbable hemostatic gauze, and those with bleeding were filled with Vaseline gauze. 1.4 Postoperative treatment Postoperative antibiotics were administered intravenously for 7-10 days, and the nasal stuffing was removed on the 3rd postoperative day, and nasal rinsing and budesonide nasal spray were performed daily with saline containing antibiotics and hormones. In the first month after surgery, nasal endoscopy was performed every 7 to 10 days, and nasal cavity cleaning was performed once to remove blood, secretions, crusts and pseudomembranes from the nasal cavity and surgical cavity, remove vesicles, small polyps and granules, separate adhesions, re-expand the sinus opening, clearly determine normal healing and pathological changes, and protect the new mucosal epithelium. In the second to sixth months, nasal endoscopic nasal clearance was performed once every 15 to 20 days until the epithelialization of the operative cavity. 2. Discussion Chronic sinusitis and nasal polyps have the characteristics of long duration and easy recurrence, and nasal endoscopic surgery is the most effective method of treatment. The perioperative management of nasal endoscopy should in principle include 1 week before surgery to 2-4 weeks after surgery, including medication strategy and treatment principles. Perioperative management should pay attention to preoperative assessment, identification of risk factors and early correction, which can effectively reduce surgical risks and postoperative complications. Appropriate preoperative application of antibiotics and hormones can control nasal and sinus inflammation and reduce mucosal edema, thus reducing bleeding during surgery, making the operative field clear and lesion removal operating within visualization, avoiding serious intraoperative complications, improving surgical efficacy, and reducing disease recurrence [4]. The operation is based on the principle of restoring and reestablishing normal sinus drainage and removing lesions and preserving the normal mucosa and structures of the nasal cavity and sinuses, removing polyps with suction cutters as much as possible and reducing the use of forceps to tear the mucosa in order to preserve the normal mucosa and structures. Avoid undue surgical injury that may lead to recurrence of sinusitis [5]. The healing of the postoperative cavity is a process of competing mucosal benign regression and development of epithelialization with pathological changes, with benign development allowing the cavity to eventually achieve ideal epithelialization, or else pathological changes leading to cavity adhesions, scar formation, and sinus stenosis or atresia, resulting in prolonged inflammation. Therefore, postoperative follow-up and regular nasal cleaning is also one of the important factors affecting the efficacy.