COMPARISION OF VASCULARITY IN RHINOLOGICAL SURGERIES -UNDERSTANDING ANAESTHETIC CONSIDERATIONS - A RETROSPECTIVE ANALYSIS

Abstract

INTRODUCTION: The procedures of otorhinolaryngology often involve either manipulation or sharing the airway and positioning of head and neck in the surgery. While the optical visualization by devices and precision of surgeries by microdebriders are advancing the anaesthetic requirements too expectantly proving advantageous and supportive towards a successful and safe surgical outcome. It has been often noted that otosurgeries need depth of anaesthesia and handling of nitrous oxide and ease of postoperative vomiting due to disturbance of vestibular apparatus during surgery, while rhino surgeries priorities clear surgical field due to high vascularity of sinonasal mucosa. The surgeries with the throat prioritise pain management and prevention of aspiration, working on control of bleeding. Anesthetic pharmacology and multiplicity of airway devices including use of microcuffed tubes and flexible laryngeal mask airway devices, have been part of a jugglery to synchronise the goals of clear surgical field and protection of airway. With newer drugs and techniques on the horizon, it is important to understand the basics of why such goals are special to rhinological surgeries. This article aims to analyse and relate the basic sciences of rhinology to the conduct of anaesthesia. As an upcoming postgraduate institution with both otorhinolaryngology and anaesthesiology, the retrospection of cases serves as an adult for improvement in future

Aims

1. To understand the anatomy and physiology and relate to anaesthetic goals in rhinological surgeries.


2. To analyse the pharmacological principles that synergize with surgical outcome.

Objectives

1. To learn from retrospection of rhinological procedures performed in our institution in the past 20 months


2. To offer recommendations for adopting strategies to improve patient safety, surgical outcome and early discharge.

MATERIAL AND METHODS

Study Type: Retrospective observational review.

Study Place: DSMCH

Study Period: January 2024 – July 2025.

Study Population: All patients recommended for rhinological surgery by the ENT surgeons.

Methods: Analysis of data from case sheets stored in medical records section.

RESULTS

374 cases of ear, nose, throat surgeries were performed of which 166 were rhinosurgeries, which is 44.38 %. All were done under endotracheal general anaesthesia as a standard protocol though pharmacological management varied with consultants.

CONCLUSION

Vascular and neural supply contribute towards the therapeutic measures to offer an oligemic field for the surgeon to perform rhino surgery Mere reduction of blood pressure with vasodilators does not offer a satisfactory surgical field. Vascular tone is mainly controlled by sympathetic innervation and sensations at touch, pain and temperature by trigeminal nerve. The goal of achieving a clear surgical field can be accomplished by using topical vasoconstrictors and by controlling sympathetic stimulation through management of pain, emotion, stress, and temperature. The variety of intraoperative drugs recommended have individual drawbacks such as lack of analgesia with metoprolol and nitroglycerine, tachycardia with nitroglycerine, lack of vasoconstriction with dexmedetomidine while vasodilation occurred with every drug. Any stimulus to the nose produces only vascular congestion due to sympathetic overactivity, the veins not in parallel with arteries and external and internal carotid contribution to vascularity further provoke vascular congestion. A combination of topical vasoconstriction, good pain relief adequate sympathetic ablation and relative bradycardia are all essential for a clear surgical field.