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Chapter 5:Preoperative Evaluation and Anesthesia

Preoperative Patient Evaluation

Preoperative planning to understand a given patient's anatomic features, to control inflammation, and to ensure adequate hemostasis is imperative if complications are to be avoided. Preoperative assessment of the patient's hemostatic screening history should include questions about bleeding during prior surgery, liver disease, use of antiplatelet or anticoagulant medications, or a family history of a bleeding disorder. Screening coagulation studies or formal hematology consultation are obtained when appropriate. Patients are restricted from using aspirin or aspirin-containing products for 2 weeks. dditional preoperative preparations can be made based on the findings of preoperative endoscopy. !or patients with sinonasal polyposis, a course of oral corticosteroid therapy can reduce polyp si"e and vascularity. Similarly, bleeding can be reduced in patients with reactive nasal mucosa by stabili"ing the mucosa with steroids prior to surgical intervention. #hen chronic infection is present, a preoperative course of oral antibiotic therapy will help reduce tissue inflammation and vascularity (McCulloch et al,1998).

$f the % mm &' endoscope cannot be introduced to the anterior attachment of the middle turbinate because of septal deviation, then it will be evident that at least a limited septoplasty will be required at the time of surgery (Kenned ,

Chapter 5:Preoperative Evaluation and Anesthesia

Prior to surgery, the patient should ideally undergo diagnostic nasal endoscopy to review the anatomy and pathology, to ensure that there has been no acute e(acerbation, and, if indicated, to take cultures to guide intraoperative and postoperative antibiotic therapy. )uring the preoperative endoscopy, access to the ethmoid cavity is re-evaluated (Kenned , !""1).