Instructional Session: ISW20

Wednesday 4 July 2018, 16.45-17.45

How I do it: Sedation and local anaesthetic technique for high risk patients undergoing functional endoscopic sinus surgery

Rohan Vithlani, Anastasia Rachmanidou, Marthin Mostert, Lewisham & Greenwich NHS Trust

Overall objective:
To present our method of sedation and local anaesthetic for patients at high risk of morbidity and mortality from general anaesthetic (GA), American Society of Anaesthesiologists Grade 3 and above, for functional endoscopic sinus surgery (FESS).

Outline of the session:
1. Discussion around the indications for FESS particularly in high risk patients
2. Discussion of the variety of methods for sedation and local anaesthetic (LA) for nasal surgery.
3. Presentation of our technique of intravenous (IV) sedation (by our anaesthetist) and LA for FESS as well as our amendments for surgical technique to enable surgery without GA.
4. Top tips for monitoring of patients’ parameters as well as how to recognise and manage patients too deep or too light.
5. Questions, comments and discussion

Learning outcomes:
1. Knowledge
1. Indications for FESS under LA and sedation
2. The variety of LA and sedation methods for nasal surgery
2. Skills
1. Step by step how to perform our technique of sedation and LA for FESS from pre-op planning, amendments to surgical technique, monitoring intra-operatively and post-op recovery using this strategy.
3. Attitude
1. Opinions from ENT rhinology specialists on variety of LA and sedation methods in use for nasal surgery and consensus on what is deemed safe in the management of high risk patients.

The session is aimed at ENT surgeons and trainees with an interest in rhinology, FESS surgery and management of high risk patients. The session is also of interest to anaesthetists, anaesthetic trainees, operating department practitioners, and ENT theatre nurses.