Why Do Some Patients Need To Be Intubated? Anesthesiology 2012;117:47586. Wawrzyniak K, Burduk PK, Cywinski JB, et al. 101. Erdivanli B, Erdivanli , en A, et al. Using the endoscope, they gently enter your nose. Koga Y. The conventional interventions, such as elevating the patients head 1520 degrees67,68 (reverse Trendelenburg position should be avoided to prevent intraoperative fluid shifts), topical decongestion of the nasal mucosa, and the use of injectable vasoconstrictors by the surgeon play an important role in optimizing the view of the operative field. Your healthcare provider will inject local anesthetic into the tissue lining your nose. PloS One 2015;10:e0127809. Gan EC, Habib AR, Rajwani A, et al. Bergese SD, Candiotti KA, Bokesch PM, et al. 23. 57. One of the primary benefits of balloon sinuplasty is that it's a safe procedure and complications are relatively rare. DeMaria S, Govindaraj S, Huang A, et al. Endoscopic Sinus Surgery | Johns Hopkins Medicine John RE, Hill S, Hughes TJ. If you smoke, please try to stop smoking at least three weeks before your surgery. The incidence of PONV is reduced with TIVA and remifentanil use, as the emetogenic effect of inhalational anesthetics is avoided148. Intubation is a common, lifesaving medical procedure. Provision of a clear and still surgical field and assuring smooth, nonstimulating emergence of anesthesia should constitute some of the top priorities for the anesthesiologist. The increased use of precision, image-guided surgery has led to improved patient safety and to a rise in functional endoscopic sinus surgery (FESS) cases performed for treatment of chronic rhinosinusitis (CRS). Tassler A, Kaye R. Preoperative assessment of risk factors. Most patients do not require nasal packing that needs to be removed. Heres some general information: All surgeries come with potential complications and risks. After locating the problem, the surgeon uses specialized instruments alongside the endoscope to open the sinuses by carefully removing causes of sinus blockage, such as mucous membrane swelling, nasal polyps and scar tissue. FESS is the most common surgery for sinus conditions. 63. Aside from remifentanil, a range of other medications have been successfully tried for improving operating conditions during FESS, but perioperative use of the 2-adrenoreceptor agonists and -blockers deserve a special discussion. You have a fever. Jaw surgery - Mayo Clinic Wormald PJ, van Renen G, Perks J, et al. Opioid prescription patterns and use among patients undergoing, 164. Experimental pain and opioid analgesia in volunteers at high risk for obstructive sleep apnea. FESS is the standard procedure to treat serious sinus conditions. Your healthcare provider may recommend you rinse your nose and sinuses with saline. The insertion procedure is brief lasting only a few minutes. They use sutures (stitches) to close the gum incision. What are the risks of intubation for surgery and anesthesia? Anesthesia for Sinus Surgery | Ento Key 2. Functional Endoscopic Sinus Surgery | AAFP Tirelli G, Bigarini S, Russolo M, et al. Intubation Explained: Purpose, Risks, and Recovery - Verywell Health J Allergy Clin Immunol Pract 2017;5:106170. Aujla KS, Kaur M, Gupta R, et al. Factors affecting unanticipated hospital admission following otolaryngologic day surgery. Intraoperative access to the patients airway is highly restricted, as the OR table is usually turned 90 or 180 degrees away from the anesthesiologist. Society of. Editor - We read with interest the case report by Piepho et al(1) suggesting an algorithm for nasotracheal intubation. Sinus Surgery for Treating Chronic Sinusitis - WebMD Most people recover from sinus surgery within a few days. Under moderate CH, synergistic interactions of IV propofol and remifentanil optimize surgical field through a combination of cardiac negative chronotropic and inotropic effects70,71,73,7885. 160. Wolters Kluwer Health Appendix A. No effect of adjusting the CO2 levels to either hypocapnia or hypercapnia94, choosing pressure-controlled versus volume-controlled ventilation133, with or without positive end-expiratory pressure (PEEP)132 could be demonstrated, but lowering mean inspiratory pressure below 15cmH2O was found to be beneficial if PEEP was used concomitantly132. Otolaryngol Clin North Am 2016;49:51729. One, is the Bailey maneuver134, which involves insertion of the LMA behind the existing ETT at a sufficiently deep plane of anesthesia, removal of the ETT, and administration of the ventilatory support through the LMA until the return of spontaneous ventilation and awakening from anesthesia. Preoperative administration of systemic antibiotics or steroids to counteract active infection and decrease tissue swelling will vary depending on surgeons preference22. It is used to: 2 Protect the airway if there is a threat of an obstruction Give anesthesia for surgeries involving the mouth, head, or neck (including dental surgery) What to Expect When Intubated Intubation is a common procedure. 55. A main and additional specific literature searches using MeSH terms, title words, and text words were performed in PubMed for the years January 1, 2000 to October 27, 2019 (Appendix 1). You should see your healthcare provider for follow-up visits a few weeks after your surgery so they can clean your nose and check on your progress. Chang CH, Lee JW, Choi JR, et al. Surgical conditions during FESS; comparison of dexmedetomidine and, 116. 50. Cardiac and anti-HTN medications should usually be continued in the perioperative period. Cattano D, Rane M. Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control. Local and regional anesthesia (eg, sphenopalatine ganglion block) facilitates MAC cases, and its use is widespread to supplement general anesthesia, which is performed far more frequently. Your FESS may not solve your sinus condition because its a chronic condition, but FESS can significantly ease your symptoms and limit how often your chronic sinus flares. Otolaryngol Clin North Am 2016;49:53147. The additional advantage of IV esmolol may be related to its ability to potentiate opioid-induced analgesia, decrease the incidence of postoperative nausea and vomiting, and improve the overall patients recovery room profile118120,122131. Most people have sinus surgery because they have severe sinus problems that medication hasnt helped. The forehead sensors for electroencephalogram-based assessment of the depth of anesthesia usually do not interfere with intraoperative use of stereotactic navigation system by the surgeon and can be particularly beneficial when TIVA is used. 12. Anaesthesia 1991;46:3667. Clonidine or, 99. The indication for surgery may be purely cosmetic, post trauma, reconstructive after tumor resection or to improve nasal breathing. 28. Br J Anaesth 2002;89:85762. Svider PF, Nguyen B, Yuhan B, et al. Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after, 152. Krings JG, Kallogjeri D, Wineland A, et al. Another approach to extubation is ventilation through an extraglottic tracheal tube135. Comparison of sodium nitroprusside- and esmolol-induced hypotension for, 79. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. 60. Use of (2)-adrenergic agonists to improve surgical field visibility in endoscopy sinus surgery: a systematic review of randomised controlled trials. Lastly, the postoperative period for patients undergoing FESS is discussed with an emphasis on approaches that facilitate prompt hospital discharge with high patient satisfaction. 88. The enhanced sensitivity of OSA patients to opioids and benzodiazepines39,40 may lead to rapidly developing respiratory depression and airway obstruction. Jun NH, Lee JW, Song JW, et al. 31. The main goals of sinus surgery are to relieve your symptoms and cut down on how many . Simple sinus surgery may only require a small dose such as 4mg IV dexamethasone; however, more extensive polyposis may require a dose up to 12mg to further decrease postoperative edema. 135. Intubation: When Needed, Benefits, and Risks - Healthline 74. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Complications may include: Persistent sinus pain and stuffiness arent life-threatening medical conditions but they can affect your quality of life. 119. During this process, the nurse removes the air from the inflated gasket on the tube and releases the ties or tape that holds the tube in place. Joshi GP, Ankichetty SP, Gan TJ, et al. The most suitable candidates for this procedure have recurrent acute or . Tramr M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. 40. The properly placed FLMA creates a reliable oropharyngeal seal, adequately protecting the lower airway from blood, secretions, irrigation fluid and surgical debris48,5557. People who undergo the procedure might develop a sinus infection. Impact of the modality of mechanical ventilation on bleeding during pituitary surgery: a single blinded randomized trial. Oral and maxillofacial surgery: To facilitate surgical access, patients may require nasal or submental orotracheal intubation. It is common for patients to be on a variety of oral anticoagulants prior to elective FESS, and plans for cessation of anticoagulants and antiplatelet agents for high risk patients should be formulated in consultation with patients cardiologist or primary care physician15,16. Total intravenous anaesthesia in endoscopic sinus-nasal surgery. Vaccines & Boosters | Testing | Visitor Guidelines | Coronavirus. You can help prevent recurring sinus problems by following your post-surgery care and giving your nose time to heal. For the most part, FESS has relatively few complications. The sinuses are a group of spaces formed by the bones of your face. Highlight selected keywords in the article text. For example, abdominal surgery usually involves administration of muscle relaxants for relaxation if the abdominal wall, which usually is an indication for intubation. Ellsworth WA, Basu CB, Iverson RE. As a result, while the intensity of arterial bleeding during FESS will be mainly influenced by MAP and HR8082, other factors, such as local mechanisms regulating functional capillary networks and venous pressure may play a significant role in regulating overall nasal capillary perfusion94. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease. Turan A, You J, Egan C, et al. You may have other follow-up visits, depending on your situation. Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. You may search for similar articles that contain these same keywords or you may Nasogastric Tubes: How Do They Impact Your Health? - WebMD Comparing the reverse Trendelenburg and horizontal position for, 69. 2. Srivastava U, Dupargude AB, Kumar D, et al. Functional Endoscopic Sinus Surgery: Prep and Recovery - Verywell Health Anesth Analg 2000;90:699705. There are certain recurring patterns of inflammatory sinus disease that may be seen on sinus computed tomography (CT). You wont be able to drive after surgery, so youll need someone to take you home and stay with you that first night. Nasotracheal intubation (NTI) involves passing an endotracheal tube through the naris, into the nasopharynx, and the trachea, most commonly after induction of general anesthesia in the operating room. Machata AM, Illievich UM, Gustorff B, et al. Amorocho MC, Fat I. Anesthetic techniques in endoscopic sinus and skull base surgery. Intubation: Purpose, Procedure and Potential Risks - Cleveland Clinic Major anesthetic objectives and strategies for, 1. 111. Adams AS, Wannemuehler TJ, Hull B, et al. Nearly 50% of patients with CRS and nasal polyposis develop comorbid asthma, which is thought to impact disease severity and deteriorate intraoperative conditions19,20. Anesthesia for Sinus Surgery. Hanna BMN, Crump RT, Liu G, et al. The effect of deliberate hypercapnia and hypocapnia on intraoperative blood loss and quality of surgical field during, 95. The patients with either known or presumed OSA should undergo outpatient surgery only if their cardiovascular and pulmonary comorbidities are optimized and will especially benefit from multimodal approach to perioperative analgesia38,41,42. Anesth Analg 2010;111:835. Intubation: What is it, types, procedure, side effects, and pictures Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Obese patients have a higher incidence of adverse airway events on induction and emergence from anesthesia37. 130. Sajedi P, Rahimian A, Khalili G. Comparative evaluation between two methods of induced hypotension with infusion of, 132. If inhalational anesthetic is chosen for maintenance, sevoflurane may be preferred, as it reduces the incidence of coughing and postoperative agitation compared with desflurane, and produces less somnolence and PONV compared with isoflurane6366. 124. Smooth emergence in men undergoing nasal surgery: the effect site concentration of, 138. Please try after some time. Tel. Atef A, Fawaz A. The perioperative use of an oral (eg, metoprolol) and IV -blockers (eg, esmolol, labetalol) desirably elicits negative chronotropic and inotropic effects, resulting in improved operating conditions89,116121. Gengler I, Carpentier L, Pasquesoone X, et al. Chaaban MR, Baroody FM, Gottlieb O, et al. This surgery widens the drainage passages between your nose and your sinuses, removing bone or infected tissue so mucus trapped in your sinuses can get out. 108. During the procedure, the healthcare provider inserts the endoscope into your nose. Even small amounts of aspirin can increase how much you bleed during and after your surgery. The effect of sphenopalatine block on the postoperative pain of. Perioperative considerations for patient safety during cosmetic surgerypreventing complications. Sometimes hospital patients just need additional nutrition to support their healing. The essential anesthesia requirements for FESS include airway management considerations for facilitating surgical access, provision of a clear and still surgical field for precision surgery, assuring quick and nonstimulating emergence from anesthesia, and fast-tracking patients for discharge (Table 1). Balloon Sinuplasty: Preparation, Recovery, Long-Term Care - Verywell Health Studies have shown that scheduled oral acetaminophen can provide effective pain control and reduced opioid requirements in the days after surgery146, and the initial investigations into the value of perioperative IV acetaminophen use for pain control after FESS seem encouraging although no definitive conclusions can be made147. Patients with diabetes mellitus and those with rheumatologic diseases may be particularly prone to bruising and delayed healing, and will require careful intraoperative positioning. 4. Oral O2 administration makes capnography monitoring unreliable, and placement of the precordial stethoscope over the patients trachea to monitor breath sounds may be recommended. Sinus surgery may involve removing infected sinus tissue, bone or polyps. Policy. A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation. They may prescribe medications that prevent infection or swelling. 13. If a deviated septum causes breathing problems, specialized instruments can straighten the septum and reduce the size of the turbinates (bony structures inside the sinuses). While infiltrative submucosal local anesthesia is used commonly by the surgeon intraoperatively, adequate analgesia may be difficult to attain secondary to preexisting mucosal inflammation, extensive polyposis, bleeding and other technical difficulties158. Soppitt AJ, Glass PS, Howell S, et al. E-mail address: [emailprotected] (A. Saxena). They may also prescribe antibiotics to help prevent infection. Coloma M, Chiu JW, White PF, et al. Anesthesiology 2006;105:88591. Hall JE, Uhrich TD, Barney JA, et al. Anesthetic management for FESS presents some unique anesthesia-related considerations. Cleveland Clinic is a non-profit academic medical center. Nekhendzy VJaffe RA, Samuels SI, Schmiesing CA, Golianu B. Rhinology 2017;55:27480. Moderate, 81. modify the keyword list to augment your search. 5. 105. This is referred to as an asleep-staged extubation and involves withdrawal of the tracheal tube until the tip rests above vocal cords in the supralaryngeal space. 131. Arch Surg 2004;139:6772. It is common for surgeons to inject local anesthetic with epinephrine into the nasal mucosa, but it should be noted that preoperative pharmacologic -blockade could lead to an exaggerated intraoperative hypertensive response to intranasally injected epinephrine-containing solutions14. Nasal saline irrigation flushes out the nasal and sinus cavities to manage polyps. Other intraoperative techniques for postoperative pain control that show early promise include topical fentanyl application to nasal packs and intraoperative infusion of magnesium159,160. Learn how we can help 4.4k views Answered >2 years ago Thank There are several types of sinus surgeries designed to be less invasive so you can recover quickly. Both the anesthesiologist and surgeon should be aware of this potential occurrence and the risks and benefits should be discussed. Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery. Your healthcare provider will administer general anesthesia just before your surgery begins. Kelly EA, Gollapudy S, Riess ML, et al. Smoking can make your sinus symptoms worse. Blackwell KE, Ross DA, Kapur P, et al. A comprehensive literature review (years 20002019) was performed with a focus on FESS topics related to preoperative patient evaluation and preparation, airway management, and optimization of the major anesthetic and surgical goals. Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care. The nonsteroidal anti-inflammatory medications (NSAIDs) and herbal supplements such as the 4 Gs (garlic, ginkgo biloba, ginseng, ginger) and certain vitamins (eg, vitamin E), may provoke microvascular bleeding and should ideally be discontinued at least 1 week before surgery when possible17,18. to maintaining your privacy and will not share your personal information without Inflammatory bowel disease (IBD). Simple sinus surgery may only require a small dose such as 4 mg IV dexamethasone; however, more extensive polyposis may require a dose up to 12 mg to further decrease postoperative edema. Search for Similar Articles Intranasal atomised dexmedetomidine optimises surgical field visualization with decreased blood loss during, 113. You have pain that your pain medications cant ease. Endotracheal Tube: Uses, Procedure, Risks, and More - Verywell Health Cleveland Clinic is a non-profit academic medical center. Endoscopic sinus surgery; Functional endoscopic sinus surgery; Anesthesia; General anesthesia; Laryngeal mask airway; Controlled hypotension; Deliberate hypotension; Total intravenous anesthesia; Remifentanil. Bairy L, Vanderstichelen M, Jamart J, et al. Healthcare providers use general or local anesthesia when they do sinus surgery. Endoscopic sinus surgery is the name given to operations used for severe or difficult to treat sinus problems. Doctors often perform it before surgery or in emergencies to give medicine or help a person breathe. Br J Anaesth 2017;118:95960. When you sneeze, you may blow out bloody discharge or mucus. National survey on the use of preoperative systemic steroids in, 27. The strategies to achieve these objectives are discussed below. Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. Stevens WW, Peters AT, Hirsch AG, et al. Patients who have sustained trauma or have soft-tissue infection present for urgent surgery with a potentially difficult airway. Last reviewed by a Cleveland Clinic medical professional on 04/04/2022. Using 3 strict criteria for proper FLMA placement and function during administration of the positive pressure ventilation (PPV), such as the ability to achieve and/or maintain adequate ventilation (tidal volume, 6mL/kg), airway protection from above the cuff (airway sealing pressure, >12cmH2O), and adequate separation of the respiratory and gastrointestinal tracts (absent gastric insufflation during PPV), Nekhendzy et al58 have demonstrated a nearly 93% overall success rate of intraoperative FLMA use by experienced operators. Esophageal perforation: life threatening complication of endotracheal Drummond GB. Functional endoscopic sinus surgery (FESS) is the primary approach used today for the surgical treatment of chronic sinusitis. Comparison of, 93. The use of esmolol as an alternative to, 129. 163. Kesimci E, ztrk L, Bercin S, et al. For practical purposes, the patients with severe OSA should not routinely undergo outpatient FESS surgery under general anesthesia or sedation4. Jacob SM, Chandy TT, Cherian VT. Selective alpha2-adrenergic properties of dexmedetomidine over clonidine in the human forearm. Avoid blowing your nose for at least seven days. Comparison of cognitive, ambulatory, and psychomotor recovery profiles after day care, 66. Endoscopic sinus surgery, sometimes called functional endoscopic sinus surgery (FESS) is a minimally invasive procedure to treat problems in the sinuses. Eur J Anaesthesiol 2017;34:65864. Nasal Endoscopy | Johns Hopkins Medicine Main literature search (the numbers represent the specific, (paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (endoscopy [mesh] OR endoscop* [tw]) AND (postoperat* [tw] OR Postoperative Complications [mesh] OR postoperative period[mesh] OR complication* [ti]) AND English [lang]. A steadfast maintenance of intraoperative normothermia is also important for the elderly29. Role of corticosteroids in. Healthcare providers may also recommend surgery if you have nasal polyps. Modir H, Modir A, Rezaei O, et al. 126. Heres an overview of the process: This is an alternative to FESS. Nasopharyngeal Airway - StatPearls - NCBI Bookshelf The effect of beta-blocker premedication on the surgical field during, 90. After surgery, you will spend a few hours in a recovery room to allow you to wake . 32. An anatomic approach to local. You do not have to be intubated for all General anesthetic. Auris Nasus Larynx 2010;37:17884. Risks and Complications NG tube feeding can cause unpleasant side effects like reflux, nausea, and vomiting in some people. Kaplan A, Crosby GJ, Bhattacharyya N. Airway protection and the, 51. Suzuki S, Yasunaga H, Matsui H, et al. J Am Coll Cardiol 2014;64:e77137. Kheterpal S, Han R, Tremper KK, et al. 109. 61. Puthenveettil N, Rajan S, Kumar L, et al. The Royal College of Anaesthetists and the Difficult Airway Society; 2011:20811. The use of the centrally acting 2-adrenoreceptor agonists, such as clonidine or dexmedetomidine, produces a dose-dependent reduction of the central sympathetic outflow, with resultant decrease in blood pressure and HR. Mouth and throat irritation may result from surgeries that involve the mouth, nose, and throat. Kim DH, Kim S, Kang H, et al. Blood loss during, 91. 162. Ebert TJ, Hall JE, Barney JA, et al. Nevertheless, the anesthesiologist should be aware that the surgery itself presents an independent risk factor for an unanticipated overnight hospital admission, and for early hospital readmission due to nasal bleeding, pain, or intolerance of nasal packing or dressing10,11. Intravenous, 82. Youll have gauze under your nose to catch drainage that youll need to replace as the gauze becomes wet. Making these corrections may also improve your facial appearance. Get useful, helpful and relevant health + wellness information. Raikundalia MD, Cheng TZ, Truong T, et al. 107. They may have mild to moderate pain for about a week after surgery. 24. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Local anesthesia removes the need for airway management, may shorten the operating time and reduce blood loss, eliminates the general anesthesia emergence phenomena, reduces the incidence of postoperative nausea and vomiting (PONV), and facilitates patients discharge4,43,44. 44. 157. A deviated septum can make it harder to breathe through your nose and can increase the risk of sinus infections due to poor drainage. Nevertheless, many of the patients with nasal polypoid disease will have received a preoperative course of oral steroid therapy in an attempt to reduce intraoperative bleeding and improve surgical visibility2328. Your healthcare provider puts decongestant medication in your nose. Minimizing the rise in blood pressure could be accomplished by administering additional anti-hypertensive agents besides -blockade at the time of local anesthetic injection or by decreasing the concentration of epinephrine in the local anesthetic mixture if possible4,14,15. Dexmedetomidine has been extensively studied due to its dose-dependent sedation and anxiolysis, potentiation of the opioid analgesia, absent or minimal respiratory depression, and additional antisialagogue, antitussive and sympatholytic properties102110. Outpatient FESS can be considered a low-risk surgical procedure, with similar rate of major complications (cerebrospinal fluid leak, meningitis, hemorrhage, orbital injuries) recorded for both primary and revision cases (0.36% vs. 0.46%, odds ratio=1.26; 95% confidence interval: 0.792.00)8. Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a pre-operative single dose versus a 5-day course of corticosteroid. Jacobi KE, Bohm BE, Rickauer AJ, et al. 106. Desflurane versus sevoflurane for maintenance of outpatient, 67. Parida S, Badhe AS. Patients discharge can be further facilitated by aggressive PONV prophylaxis, usually with IV 5-HT3 antagonist (eg, ondansetron 48mg) and IV dexamethasone (812mg), which is routine for FESS. Chung F, Memtsoudis SG, Ramachandran SK, et al. 1. Turbinate reduction is surgery to reduce the size of your turbinates. your express consent. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546409/), (https://www.ncbi.nlm.nih.gov/books/NBK563202/#_NBK563202_pubdet_). Before you leave, your provider will give you information about taking care of yourself as you recover. Gomez-Rivera F, Cattano D, Ramaswamy U, et al. Boezaart AP, Van der Merwe J, Coetzee A. Your provider may prescribe pain medication to help with the mild or moderate pain you may have for a week or so after your surgery. Khosla AJ, Pernas FG, Maeso PA. Meta-analysis and literature review of techniques to achieve hemostasis in. Proper anesthetic management, however, can indirectly decrease blood loss during FESS by improving the operating conditions and allowing for a more rapid surgery94. Cassano M, Longo M, Fiocca-Matthews E, et al. The effect of the, 83. the use of FLMA may offer significant advantages, including decreased incidence of the upper airway trauma and adverse respiratory events, facilitation of maintenance of anesthesia and quality of surgical field, and smoother and faster emergence from anesthesia4,4754. Functional endoscopic sinus surgery (FESS) is minimally invasive surgery for serious sinus conditions. Your healthcare provider puts decongestant medication in your nose.