Hypotensive Anaesthesia for FESS with LMA Management

You are taking over a functional endoscopic sinus surgery (FESS) case from a colleague in a private hospital because the morning list is running over time and the colleague needs to leave. The handover given is that the patient is a 50-year-old man undergoing a FESS with mechanical positive pressure ventilation (PPV) using a flexible laryngeal mask airway (LMA). Anaesthesia is being maintained with target-controlled infusions of propofol and remifentanil. Observations have been stable with a targeted mean arterial pressure (MAP) of 65 mmHg after the surgeon requested hypotensive anaesthesia. Medical History Obstructive sleep apnoea on nocturnal CPAP Hypertension, preoperative BP 130/63 mmHg (MAP 85 mmHg) Smoker 10 cigarettes/day with a 20-pack-year history Medications Amlodipine 5 mg once daily Allergy Nil known drug allergy Observations HR 70 bpm BP 100/47 mmHg (MAP 65 mmHg) SpO2 98% on FiO2 40% Temp 36.5°C Weight 90 kg Height 177 cm BMI 29 kg/m2