Objectives This systematic review aims to explore and outline the anaesthetic considerations and precautions for patients with a diagnosis of hereditary haemorrhagic telangiectasia (HHT) undergoing nasal surgery. Design A search was performed across four electronic databases between the dates 1 st January 2000 and 1 st March 2024. Two independent reviewers selected articles that met the following criteria: adult patients with HHT undergoing nasal surgery; description of anaesthetic regime; English language. Case reports and reviews were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed throughout. Results and participants Nine studies were included in the analysis, comprising a total of 800 patients. Two studies described local anaesthetic (LA) only, two described general anaesthetic (GA) only, and five described cases of each. Modality of anaesthesia was dependent on type of procedure (laser therapy, endoscopic surgery, sclerotherapy, or plasma coagulation) and patient factors (including HHT disease severity, vascular anatomy, and age). Anaesthetic approaches varied, although there were similarities; for example, six studies used a topical LA, combined with a vasoconstrictor. Only one study described a GA regime. Reduction of intra-operative bleeding was highlighted across multiple studies; measures included endotracheal tube/nasal lubrication, decongestants, and controlled hypotension. Complications were generally low, with three studies, totalling 218 patients, describing procedures in-clinic with LA with no reported complications. Conclusion The literature lacks clear consensus for selecting between LA or GA, as well as evidenced regimes for both. Therefore, further research is needed to better inform the anaesthetic approach for HHT patients undergoing nasal surgery.

Objectives We set out to create Consensus Guidelines, based on current evidence and relative risks of adverse effects and the costs of different treatments, that reflect the views of the British Rhinological Society (BRS) Council on where the use of biologics should be positioned within treatment pathways for CRSwNP, specifically in the setting of the National Health Service (NHS). Methods An expert panel of 16 members was assembled. A review of the literature and evidence synthesis was undertaken and circulated to the panel We used the RAND/UCLA methodology with a multi-step process to make recommendations on the use of biologics. Setting and participants N/A Results Recommendations were made, based on underlying disease severity, prior treatments and co-morbidities. A group of patients for whom biologics were considered an appropriate treatment option for CRSwNP was defined. Conclusions Although biologics are not currently available for the treatment of CRSwNP, the BRS Council have defined a group of patients who have higher rates of ‘failure’ with current treatment pathways, higher resource use and are more likely to suffer with uncontrolled symptoms. We would urge NICE to consider approval of biologics for such indications without applying further restrictions on use.