title: The quality of the surgical field during functional endoscopic sinus surgery--the effect of the mode of ventilation--a randomized, prospective, double-blind study.
abstract: OBJECTIVE
  The outcome of functional endoscopic sinus surgery (FESS) depends on a clean surgical field achieved by minimizing intraoperative bleeding. High frequency jet ventilation (HFJV), due to lower airway pressures, offers the benefit of improved venous return, less bleeding, and improved operating conditions. HFJV was compared to intermittent positive pressure ventilation (IPPV) by assessment of surgical conditions and measurement of intraoperative blood loss.
  
  
  METHODS
  Prospective, randomized, double-blind study.
  
  
  METHODS
  A total of 22 patients undergoing FESS were randomly assigned to be ventilated during surgery under general anesthesia by either HFJV or IPPV. The quality of the surgical field was assessed and the total blood loss was measured.
  
  
  RESULTS
  The mean airway pressure was significantly lower in the HFJV group than in the IPPV group (2.42 +/- 1.17 and 7.11 +/- 0.72, respectively, P < .0001). The total mean loss of blood in the HFJV group was 170 cc and in the IPPV group was 318.18 cc (P = .017). The quality of the surgical field as estimated by the surgeon was significantly better in the HFJV group. The mean point values on the Boezaart et al. scale for the IPPV and HFJV groups were 2.72 +/- 0.77 and 1.80 +/- 0.686, respectively (P = .012).
  
  
  CONCLUSIONS
  HFJV significantly reduced the amount of intraoperative bleeding and thus significantly improved the quality of the surgical field. It is suggested that increased venous return due to lower intrathoracic pressures resulted in less bleeding and improved operating conditions. HFJV can be effectively used for FESS in order to improve endoscopic view with no adverse effects.
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Ziv Hospital, Safed,, Western Galilee Hospital, Nahariya, Israel. pgilbey@bezeqint.net
authors.forename: Peter
authors.initials: P
authors.lastname: Gilbey
authors.forename: Yevgeny
authors.initials: Y
authors.lastname: Kukuev
authors.forename: Alvin
authors.initials: A
authors.lastname: Samet
authors.forename: Yoav
authors.initials: Y
authors.lastname: Talmon
authors.forename: Simon
authors.initials: S
authors.lastname: Ivry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D004724:Endoscopy / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006611:High-Frequency Jet Ventilation / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult