25
Postoperative Care of the Patient
Undergoing Endoscopic
Sinus Surgery
Although the method used, technology employed, and technical skill of the surgeon are important to achieving an excellent result, of equal importance is the care given to the patient following surgery. Postoperative care may be considered as immediate (in the recovery and ambulatory surgery center) and later as both home care and office care.
The author performs nearly all endoscopic sinus surgery in the ambulatory surgery facility. Patients remain in the facility until their vital signs are stable, there is reasonable level of consciousness, bleeding is minimal, and there is as much certainty as possible that no serious complications have occurred. (Details of the care given in the ambulatory surgery facility are reviewed in Chapter 26.)
Patients are given detailed instructions at the time of scheduling of their surgery. These instructions include a brief description of endoscopic sinus surgery in addition to information in preparation for surgery and expectations for the day of surgery.
The instruction brochure describes how to prepare for surgery, what to expect on the day of surgery and the first week after surgery, and includes information about physical activity, rest, nasal care, sneezing, moisturizing the nasal cavity, and pain. It describes the first postoperative office visit and the nasal endoscopy that is performed at that time.
Patients are discharged with a “postoperative home-going bag.” This includes 2 × 2 inch gauze nasal dressings and nonallergic tape. They are instructed to wear the dressing for comfort to catch any blood or mucus, which usually lasts for ~24 hours. If the dressing becomes saturated more often than every 10 minutes, they are told to contact the surgeon. If excessive bleeding is present while at home, patients are advised to use oxymetazoline or neosynephrine nasal spray every 10 minutes for 30 minutes. If the bleeding persists in spite of this, they either return to the surgeon’s office or go to the nearest emergency room.
The postoperative home-going bag also includes a sample bottle of nasal saline spray. Patients begin the spray the next day and use it 4 or 5 times a day. Cotton-tipped applicators are included. These are dipped in hydrogen peroxide to remove any dry blood in the nares of the nose. Patients are told not to blow their nose until after the first postoperative visit because this may stimulate bleeding.
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