Functional Endoscopic Sinus Surgery: A Comparative Study of Monitored Anaesthesia Care and General Anaesthesia

Background: Functional endoscopic sinus surgery is associated with a high rate of success for symptomatic improvement in patients. This operation can be done under general or local anesthesia. In this study we have tried to compare the efficacy of monitored anesthetic care with general anesthesia for Functional endoscopic sinus surgery. Methods: 20 patients each above the age of 18 years, were selected for Monitored anesthesia care (MAC) and for general anesthesia (GA). For MAC, 150mg Tab Ranitidine at BT/6AM, Tab Perinorm 10mg at BT /6AM, Tab Diazepam 5mg at BT /6AM was given as pre medication schedule. Inj Pentacozine 30mg + Inj Promethazine 25mg I/M was given 30–45 mins before the patient was shifted to OT. On the table Inj. Midazolam 1-3 mg was given which has 3–4 Ramsey sedation score .Inj Fantanyl 1mcg/kg weight was given for break-through pain. The GA technique used was Inj. Fantanyl 1 mcg/ kg weight + Inj Midazolam 1-2 mg; Inj Propofol 2mg/kg, Sch 2mg/kg was given, intubated by intermittent positive pressure ventilation (IPPV). Vecuronium 0.1mg/kg + Isoflurane 0.6–1% + N2O 2l/mt +o2 1l/mt was given followed by neostigmine 2.5mg+Glycopyrrolate 0.4mg. Results: There was a 15% increase in heart rate within 12 minutes of sedation in MAC and 20% in GA. The percentage of variation after 15 minutes remained at 15% in case of GA but it reduced to 5% in MAC and remained steady at this rate. 10% of the patients started to respond almost immediately after surgery in the MAC category and 100% of them were conscious within 90mins of surgery, while under general anesthesia, only 80% of them attained consciousness after 120 minutes. It took about 120 minutes for all patients under MAC for ambulation while it took more than 150 minutes for the patients under GA for ambulation. No patient under MAC had any side effects while 60% of the patient under GA ha nausea, vomiting or both. Conclusion: With no complications of extubation and mechanical ventilation, having faster recovery time, with hardly any post operative nausea and vomiting, Monitored anesthetic care is a better choice of anesthesia compared to general anesthesia for elective surgeries like Functional Endoscopic Sinus surgery.