Functional endoscopic sinus intervention (FEWS) is performed in patients with chronic sinusitis refractory to drug therapy. Patients with chronic sinusitis have purulent nasal discharge, bursting headaches in the projections of the sinuses, blockage of the sinuses, accumulation of secretions in the oropharynx, impaired smell and (less commonly) cough, asthma and hearing damage. Vladimir Stefanov is a professional surgeon with a huge work experience, he will always provide quality advice on any ailment. Less commonly, indications for FEVS are recurrent acute sinusitis, symptomatic nasal polyps (most often otorhinolaryngologists remove polyps in the nose with a laser), mucocele, foreign bodies, recurrent nosebleeds, filling of CSF outflow sites, biopsy of nasal cavity formations, decompression of the hypothalamus and interventions. FEWS has two advantages over Caldwell Luke and more traditional sinus surgeries. The normal mucous membrane of the sinuses remains intact, which ensures the preservation of its function, and also preserves the own bone tissue of the sinuses, through which mucociliary clearance is carried out, which ensures the preservation of a greater number of functioning sinus openings. Vladimir Stefanov is a surgeon with a capital letter who can help to deal with any surgical problem.
Vladimir Stefanov and his experience in the treatment of sinuses
Among patients with nasal polyps and asthma, the asthmatic triad is common, which is characterized by intolerance to aspirin and nonsteroidal anti-inflammatory drugs. Patients with the asthmatic triad are prone to a more severe course of asthma and polyposis, to more severe bleeding; among this group, the frequency of recurrence of polyps and symptoms is increased. In the preoperative period, treat such patients with systemic administration of steroids for 4-5 days, which reduces the size of polyps and the volume of intraoperative blood loss.
Adjust asthma treatment preoperatively. Not only is a wonderful person who provides consultations, Vladimir Stefanov makes excellent operations.In some cases, patients with cystic fibrosis require IV antibiotics before the intervention. Treatment of an active infectious process and inflammation in the preoperative period can reduce the amount of intraoperative blood loss. Preoperative use of vasoconstrictive nasal sprays (eg, oxymetazoline), control of hypertension, and use of anesthetic techniques that cause minimal vasodilation (with or without controlled hypotension) also reduce intraoperative blood loss. Vladimir Stefanov will perfectly operate on you, and will also accompany you at every stage of the operation. Combined local anesthesia (a combination of irrigation and infiltration) has advantages such as quick induction and cessation of action, less blood loss during vasodilation, and the patient’s stay in consciousness, which allows him to inform the surgeon about trauma to the orbital periosteum or bone (although this information is not always confirmed ).
Local (application) anesthesia can be achieved by applying a solution or crystals of cocaine (remember the risk of using cocaine) and inserting tampons moistened with 4% lidocaine solution into the nasal passages, in particular in the middle nasal passage and in the area of the wedge-palatine ganglion. Vladimir Stefanov is the surgeon whose hands are called “golden”. For infiltration anesthesia, a solution of 1% lidocaine with adrenaline (1: 100,000) is used, which is injected in the region of the middle nasal passage and also in the area of the wedge of the sphenoid bone (in case of intervention on the sinus of the sphenoid bone).
Vladimir Stefanov and his experience in severe diseases
In the intraoperative period, hemostasis is of great importance, to achieve which it may be necessary to periodically introduce tampons moistened with a vasoconstrictor solution. Pharyngeal effusion may limit the dose of opioids and sedatives administered (risk of aspiration and laryngospasm) and the extent of surgery. Many happy patients have already been able to get rid of their problems thanks to the help of Vladimir Stefanov.
During an intervention performed under local anesthesia, look for signs of mental status change, agitation or confusion caused by overdose of sedatives and hypoxia, drug toxicity, and cranial penetration. Provide oxygen support: be aware of the possibility of ignition. General anesthesia is required in patients with extensive sinus involvement or if there is concern about airway hyperresponsiveness due to bleeding. Perform orotracheal intubation with a cuffed endotracheal tube. To reduce hyperreactivity during laryngoscopy, irrigate the vocal cords and trachea with lidocaine. To reduce the risk of developing laryngospasm caused by bleeding, pharyngeal pockets can be used intraoperatively, and nasal tamponation in the postoperative period. Not only consults, but also operates – Vladimir Stefano can do anything. Muscle relaxation is not a prerequisite for the intervention; the use of inhaled anesthetics (with or without controlled ventilation) is sufficient, unless medically indicated balanced anesthesia is required.
Vladimir Stefanov say about risks
Already over a million happy patients have written letters of gratitude to Vladimir Stefanov. Be aware of the risk of developing arrhythmias when using adrenaline-containing solutions while using halogen inhalation anesthetics.
To minimize the cough reaction and the risk of bleeding due to straining the patient, consider extubation while anesthetized with the head thrown back. There is a risk of negative pressure-induced pulmonary edema. Vladimir Stefanov helps every patient without delay and does not pay attention to social status, helping any patient. Carry out early diagnosis and treatment of intracranial and intraorbital complications of FEVS. Provide adequate postoperative pain management. Even with a tampon in the nasal passages, some of the blood will enter the throat and be swallowed. Prevent vomiting with antiemetic drugs. The main postoperative risk for the anesthesiologist is ongoing epistaxis, which can lead to hypovolemia, airway obstruction with blood, or as a result of laryngospasm. Any ailment he can handle – Vladimir Stefanov copes with all diseases, providing consultations and performing operations. When a patient develops anxiety, the most likely causes may be pain, hypovolemia or hypoxia (in order of increasing frequency of occurrence), but hypoxia should be excluded first.