Problems of operational bleeding during functional endoscopic operations in child

*Lechosław P. Chmielik¹, Marcin Rawicz², Mieczysław Chmielik¹

Summary
Summary
Operational bleeding during the FESS operation can be a serious problem, both because of the volume of blood lost (especially in children), and the fact that it can make the operation impossible. In reducing bleeding, an important element is the correct preparation of the patient for the operation, seeking any blood clotting complications, and correct haematological preparation of patients with these complications. Thanks to the development of operation techniques, we have the possibility of removing the chosen changes in the area of the nasal sinuses. Functional endoscopic methods of operating on the nasal sinuses have been described by Wigand and by Stammberger, These methods are based on the use of 0, 30, 70 and 120 endoscopes, and the correct set of forceps. A rinsing-suction set is an especially useful device when operating on the sinuses in children, and a micro-debrider with a set of endings at the correct angle allows the surgeon to reach the chosen area.
In FESS, intra-operational and post-operational bleeding can be a serious problem, especially with heavy bleeding or bleeding in to the orbit.
A very significant factor is the overall anaesthetic care. The anaesthetist must examine and qualify the patient with great care, and may do so in conjunction with doctors from other specialities.
All the patients were counted into 1 and 2 in ASA. Most children were not pre-medicated, but put straight on to general anaesthesia. Fifteen to twenty minutes before the end of the operation, 10 ug/Kg of morphine was given under the skin. The addition of propofol and remifentanil was stopped during the period of anterior nasal packing.
In the case of bleeding during a FESS operation, haemostasis must be achieved by physical means in addition to pharmacological.
The described method of anaesthesia seems to be optimal because of the minimising of pressure changes, helping to ensure a bloodless operating area, and comfort of the surgeon.

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