FESS surgeries can be performed either under local anesthesia with sedation or under general anesthesia. Both have advantages and disadvantages. I prefer to perform FESS under local anesthesia with sedation because I believe that the risks of general anesthesia outweigh the benefits. My patients who have had surgery under local anesthesia with sedation relay that their surgery was well tolerated. Furthermore, patients operated under local anesthesia with sedation can be more easily monitored for warning signs of impending problems. This avoids many of the complications of surgery.
Typically with local anesthesia, there is less blood loss, because the general anesthesia agents cause the blood vessels to dilate. This is a big plus when doing FESS because small specks of blood can look like a red blizzard to the surgeon who is operating through an endoscope. Moderate bleeding can obstruct the surgeon’s view and make it impossible to operate safely, necessitating that the surgeon abort the surgery if he or she cannot visualize the operative field.
There are a handful of drawbacks to consider. First, performing surgery under local anesthesia requires more skill than performing surgery under general anesthesia. If your surgeon does not feel comfortable performing surgery under local anesthesia, and you feel comfortable with his or her expertise, follow his or her recommendations for general anesthesia. Your anesthesiologist should also feel comfortable with the technique of providing sedation during this type of surgery. Many are not comfortable and that would be another indication for general anesthesia. However, I’ve found that most anesthesiologists are comfortable with these techniques.
Nervous or anxious patients might feel more emotionally secure under general anesthesia, although I have found that with proper consultation most are able to easily tolerate local anesthesia with sedation. Children generally require general anesthesia, although I have successfully
operated on adolescents whose parents have requested that the surgery be performed under local anesthesia with sedation. If a patient is having a problem tolerating local anesthesia, I can always convert them to general anesthesia during the surgery.