Anaesthesia for endoscopic endonasal surgery

Endoscopic endonasal surgeries are fast catching the imagination of both otorhinolaryngologist and neurosurgeons. Although traditionally done only for treatment of chronic rhino-sinusitis the approach is nowadays being utilised for varied pathological states on a wide anatomical expanse which is accessible via the endonasal corridor. The anatomical areas involved are not just paranasal sinuses but include the whole of the ventral base of skull, areas around the orbit and even upper cervical spine. The approach can be utilised for a myriad of pathology including resection of inflamed mucosa of the sinuses, correction of fractures of bones around nose, correction of cerebrospinal fluid rhinorhea and resection of benign and malignant tumours in paranasal sinuses and intracranially along the base of the skull. Thus it is evident that the perioperative anaesthetic management will have to be tailored according to the patient's preoperative profile and the surgical needs. There, however, are some general concerns including provision of a blood less field, maintaining a good plane of anaesthesia and allowing a smooth recovery from anaesthesia which is common to all procedures. Techniques that can be utilised to provide for these and some special concerns in particular procedures are being discussed in this review.