EC Anaesthesia

Research Article Volume 6 Issue 7 - 2020

Comparing RAMPED Position Versus Supine Position for Functional Endoscopic Sinus Surgery (FESS); A Single-Blind, Randomized, Prospective Study

Abla Saab1, Gamal Abdalla Mohamed Ejaimi2*, Randa Atwa Abdallah3 and Maher Zaki2,4

1Lecturer of Anesthesia and Intensive Care, Ain Shams University, Cairo, Egypt
2Consultant of Anaesthesia and Intensive Care. Department of Anesthesia and Intensive Care, Taiba Hospital, Kuwait
3Lecturer of Otolaryngology and Head and Neck Surgery, Al Azhar University Hospital, Cairo, Egypt
4Assistant Professor of Anesthesia and Intensive Care, Tanta University, Egypt

*Corresponding Author: Gamal Abdalla Mohamed Ejaimi, Consultant of Anaesthesia and Intensive Care. Department of Anesthesia and Intensive Care, Taiba Hospital, Kuwait.
Received: May 18, 2020; Published: June 30, 2020



Background and Aim: Functional endoscopic sinus surgery (FESS) is a procedure for surgical treatment for patients with chronic sinusitis and chronic polypus rhinosinusitis. Both the bloodless surgical field and surgical field clarity are required during the procedure. We aimed to study whether the RAMPED positioning could reduce blood loss and improve surgical field clarity during FESS.

Methods: A number of 50 patients with chronic rhinosinusitis (CRS) with and without nasal polyposis of American Society of Anaesthesiologists (ASA) grade I/II, scheduled for FESS were included in the study. They were blindly selected and randomized into two groups, 25 in each, SG (Supine Group) and RG (RAMPED Group). The total blood loss, intraoperative haemodynamic stability, surgical field clarity, consumption of sevoflurane and remifentanil, and total surgical time were assessed and compared between the two groups. Fischer test and student t. test were used to analyze the demographic and continuous variables respectively.

Results: The estimated blood loss in RG was 256.4 ± 96.8 ml as compared to to314.7 ± 107.3 ml in SG (P-value 0.0493). Better Fromme-Boezaart scoring system (FBS) for the surgical field was recorded in RG as compared to SG (1.67 ± 0.52 in RG versus 2.46 ± 0.73 in SG) (P value ≤ 0.000).

Conclusion: Our study concluded that the use of RAMPED position during FESS is associated with improvement in the surgical field, a decrease in blood loss and short operative time compared to the supine position.

Keywords: Functional Endoscopic Sinus Surgery; FESS; Supine; RAMPED; Rhinosinusitis; Sinusitis

  1. Damm M., et al. “Impact of FESS on symptoms and quality of life in chronic rhinosinusitis”. Laryngoscope2 (2002): 310-315.
  2. Kennedy D., et al. “Functional Endoscopic Sinus Surgery: Theory and Diagnostic Evaluation”. Archives of Otolaryngology - Head and Neck Surgery9 (1985): 576-582.
  3. Poetker DM and Smith TL. “Adult chronic rhinosinusitis: surgical out- comes and the role of endoscopic sinus surgery”. Current Opinion in Otolaryngology and Head and Neck Surgery 15 (2007): 6-9.
  4. Tajudeen BA and Kennedy DW. “Thirty years of endoscopic sinus surgery: what have we learned?” World Journal of Otorhinolaryngology - Head and Neck Surgery 3 (2017): 115-121.
  5. Stankiewicz JA and Hotaling J. “Medicolegal issues in endoscopic sinus surgery and complications”. Otolaryngologic Clinics of North America 48 (2015): 827-837.
  6. Rao SL., et al. “Laryngoscopy and tracheal intubation in the head-elevated position in obese patients: a randomized, controlled, equivalence trial”. Anesthesia and Analgesia 107 (2008): 1912-1918.
  7. Greenland K. “More on ramped position and 25-degree head up positions”. British Journal of Anaesthesia5 (2016): 674-675.
  8. Pant H. “Hemostasis in endoscopic sinus surgery”. Otolaryngologic Clinics of North America 49 (2016): 655-676.
  9. Nair S., et al. “The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery”. Laryngoscope 114 (2004): 1042-1046.
  10. Goldstein GH and Kennedy DW. “Long-term successes of various sinus surgeries: a comprehensive analysis”. Current Allergy and Asthma Reports 13 (2013): 244-249.
  11. Boezaart AP., et al. “Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery”. Canadian Journal of Anesthesia 42 (1995): 373-376.
  12. Carlton DA and Govindaraj S. “Anesthesia for functional endoscopic sinus surgery”. Current Opinion in Otolaryngology and Head and Neck Surgery 1 (2017): 24-29.
  13. Choi WS and Samman N. “Risks and benefits of deliberate hypotension in anaesthesia: a systematic review”. International Journal of Oral and Maxillofacial Surgery 37 (2008): 687-703.
  14. Ha TN., et al. “The effect of blood pressure and cardiac output on the quality of the surgical field and middle cerebral artery blood flow during endoscopic sinus surgery”. International Forum of Allergy and Rhinology 6 (2016): 701-709.
  15. Boonmak P., et al. “Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS)”. The Cochrane Database of Systematic Reviews 10 (2016): CD006623.
  16. Shen PH., et al. “Intravenous esmolol infusion improves surgical fields during sevoflurane- anesthetized endoscopic sinus surgery: a double-blind, randomized, placebo-controlled trial”. The American Journal of Rhinology and Allergy 25 (2011): e208-e211.
  17. Aravindan A., et al. “Magnesium sulfate or diltiazem as adjuvants to total intravenous anesthesia to reduce blood loss in functional endoscopic sinus surgery”. Journal of Clinical Anesthesia 34 (2016): 179-185.
  18. Elsharnouby NM and Elsharnouby MM. “Magnesium sulphate as a technique of hypotensive anaesthesia”. British Journal of Anaesthesia 96 (2006): 727-731.
  19. Blackwell KE., et al. “Propofol for maintenance of general anesthesia: a technique to limit blood loss during endoscopic sinus surgery”. American Journal of Otolaryngology 14 (1993): 262-266.
  20. Kelly EA., et al. “Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia”. International Forum of Allergy and Rhinology 3 (2013): 474-481.
  21. DeConde AS., et al. “Systematic review and meta-analysis of total intravenous anesthesia and endoscopic sinus surgery”. International Forum of Allergy and Rhinology 3 (2013): 848-854.
  22. Little M., et al. “Total intravenous anesthesia vs inhaled anesthetic for intraoperative visualization during endoscopic sinus surgery: a double blind randomized controlled trial”. International Forum of Allergy and Rhinology 8 (2018): 1123-1126.
  23. Brunner JP., et al. “Total intravenous anesthesia improves intraoperative visualization during surgery for high-grade chronic rhinosinusitis: a double-blind randomized controlled trial”. International Forum of Allergy and Rhinology 8 (2018): 1114.
  24. Ko MT., et al. “Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery”. Laryngoscope 118 (2008): 1687-1691.
  25. Hathorn IF., et al. “Comparing the reverse Trendelenburg and horizontal position for endoscopic sinus surgery: a randomized controlled trial”. Otolaryngology–Head and Neck Surgery 148 (2013): 308-313.
  26. Gan EC., et al. “Five-degree, 10-degree, and 20-degree reverse Trendelenburg position during functional endoscopic sinus surgery: a double-blind randomized controlled trial”. International Forum of Allergy and Rhinology 4 (2014): 61-68.
  27. Shane SM and Ashman H. “The prevention of postoperative shock and postanesthesia hypotension by use of the reverse Trendelenburg position during surgery under light, etherless, general anesthesia”. The American Journal of Surgery 94 (1957): 102-107.
  28. Gurr P., et al. “Laser-Doppler blood flowmetry measurement of nasal mucosa blood flow after injection of the greater palatine canal”. The Journal of Laryngology and Otology 2 (1996): 124-128.
  29. Fromme GA., et al. “Controlled hypotension for orthognathic surgery”. Anesthesia and Analgesia 6 (1986): 683-686.

Gamal Abdalla Mohamed Ejaimi., et al. "Comparing RAMPED Position Versus Supine Position for Functional Endoscopic Sinus Surgery (FESS); A Single-Blind, Randomized, Prospective Study". EC Anaesthesia 6.7 (2020): 15-21.

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