الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
ESS is the best choice for treatment of CRS or sinonasal polyposis after failure of medical intervention. It’s a minimally invasive procedure under direct visualization with endoscopes through the noses with no need for skin incisions. This surgery aims to re-establish sinus ventilation and normal function (Dhingra et al., 2014). Bleeding remains to form a challenge for rhinological surgeons and anesthesiologists during ESS through this narrow surgical area with its high vascularity. So small amount of blood blocks operative field vision, augments complications rate, increases operation time and may result in incomplete surgery (Paudel et al., 2018). Significant bleeding has occurred during ESS inspite of using various approaches to reduce this blood loss like head elevation, packing, topical vasoconstrictors, induced hypotension, hemostatic materials, or steroids (Mathew et al., 2017). One method which successfully reduces blood loss during ESS is GPC injection with epinephrine. Diluted epinephrine infiltrated into PPF via GPC causes vasoconstriction of the 3rd portion of maxillary artery. So, it reduces blood flow into its branch sphenopalatine artery, the chief vessel of nasal cavity, with subsequent reduction in blood supply to the mucosa of nasal cavity (Shenoy et al., 2017). This study was conducted on 40 subjects indicated for ESS as they were diagnosed with persistent bilateral CRS or bilateral sinonasal polyposis above 18 years old with a mean age of 42.45 ± 7.1 years. Under hypotensive general anaesthesia, only one side of lateral nasal wall was injected with 2 ml 1:200.000 epinephrine, whereas on the other side GPC was infiltrated with the same concentration, to compare among both sides on intraoperative bleeding and time during ESS. This study with its result supports the safety and efficacy of GPC injection with epinephrine under hypotensive general anaesthesia on reducing bleeding during ESS, decreasing bleeding grade with improvement of operative field significantly at 15 and 30 minutes, also decreasing operative time and increasing surgeon satisfaction compared to the conventional injection method of lateral nasal wall injection with epinephrine with no or minimal complications.