Chronic sinusitis and nasal polyps during the operation period and the observation of the effect of operative treatment on intraoperative bleeding (167.55 ± 14.64) ml, with both showing statistically significant differences. Among these, control of bleeding risk factors: For potential risk factors that may cause intraoperative or postoperative hemorrhage, preoperative controls are necessary, such as hypertension, diabetes mellitus, history of nasal surgery, smoking, and drinking habits. In diabetic patients, and hypertensive patients, attempts should be made to control systolic blood pressure at around 130mmHg, diastolic blood pressure below 80mmHg, and diabetic patients' glycemic levels should be controlled within 8.0mmol/L. The female menstrual period, respiratory tract infections should suspend the operation; blood diseases, coagulation inhibitory barriers should avoid the operation.
Thirdly, sufficient time for full contraction of the middle meatus of the nose, nasal mucosa, and nasal vessels caused by surgery: Bleeding is often due to the anterior ethmoidal artery and branches of the sphenopalatine artery. Preoperative good surface anesthesia of the mucosa and infiltration anesthesia can achieve dual purposes of anesthetic nerve block and vasoconstriction. Good contraction is key to reducing intraoperative bleeding. Surface anesthesia in two stages, the first stage for coarse anesthesia, using systolic total nasal meatus, the second stage for fine anesthesia, striving to accurately place the anesthetic cotton piece in the middle nasal meatus and the olfactory cleft position. Then submucous infiltration anesthesia, mainly in the uncinate process, in three areas, and the outside posterior attachment of the middle turbinate, lateral side of the posterior attachment of the middle turbinate, aiming at contracting the anterior ethmoidal artery and the sphenopalatine artery. General anesthesia operations can replace the contraction water, and there should be at least a 5-minute interval between anesthesia and the operation to achieve full vasoconstrictive effects.
Fourthly, normative operations reduce mucosal injury. Nasal blood supply is very rich, normative operations can reduce operation time and minimize mucosal injuries as much as possible, which not only conforms to the principle of nasal endoscopic operations but also is a good way to reduce intraoperative bleeding. Operations should use nasal polyps mucosa forceps cutters as far as possible to excise lesions, decreasing mucosal tearing actions.
Fifthly, control of low-pressure anesthesia: Data show that general anesthesia has more bleeding than local anesthesia, but in general anesthesia with controlled hypotension, mean arterial pressure dropped to 50--65mmHg, it can reduce vascular tension, reduce bleeding, make the operation visual field clear, improve operation accuracy, reduce accidental nerve and blood vessel injuries, facilitate the operation, shorten operation time, reduce edema degree, and speed up wound healing. According to the brain, heart, kidney, and other organs' tolerance to ischemia and hypoxia, the currently accepted "safe" limit for controlled hypotension is a low mean arterial pressure of 50--55mm Hg. However, due to individual differences, the ideal voltage level depends on age, physical status, patient positioning, and surgical needs, so the mean arterial pressure is controlled within 50~65mm Hg (or systolic blood pressure not less than 80mmHg), with the blood pressure dropping to two-thirds of the preoperative blood pressure. During the operation, attention should be paid to indicators such as electrocardiogram, oxygen saturation, urine output, etc., and discretion should be exercised if changes occur.
Sixthly, strictly control the operation time: We found that nasal sinus operations are best done within 1 hour, as longer durations make bleeding more difficult to control. According to pharmacological principles and practice, submucosal epinephrine application is available for 1 hour, after a 4-hour interval, it can be used again; otherwise, it will cause long-term exposure of the epinephrine body to agonists, reducing response or reaction.