scholarly journals Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS)

2015 ◽  
Vol 31 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Sahar M. El Shal ◽  
Riham Hasanein
Keyword(s):  
Tranexamic Acid ◽  
Endoscopic Sinus Surgery ◽  
Aminocaproic Acid ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Field Quality ◽  
Surgical Field ◽  
Epsilon Aminocaproic Acid

Dexmedetomidine improves the quality of the operative field for functional endoscopic sinus surgery: systematic review

2015 ◽  
Vol 129 (S3) ◽  
pp. S8-S13 ◽  
Author(s):  
K Snidvongs ◽  
W Tingthanathikul ◽  
S Aeumjaturapat ◽  
S Chusakul
Keyword(s):  
Systematic Review ◽  
Endoscopic Sinus Surgery ◽  
Operative Time ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Operative Field ◽  
Field Quality ◽  
Surgical Field ◽  
Randomised Controlled

AbstractBackground:Intra-operative bleeding diminishes visualisation during functional endoscopic sinus surgery and can cause unfavourable outcomes. Dexmedetomidine is a potent alpha-2 agonist, with sympatholytic effects. This systematic review aimed to assess whether dexmedetomidine decreases intra-operative bleeding and improves operative field quality.Methods:All randomised, controlled trials that assessed the ability of dexmedetomidine to provide good operative fields for functional endoscopic sinus surgery were identified from Medline and Embase. The outcomes of interest were: operative field quality, intra-operative bleeding, operative time and adverse events.Results:Five studies (254 patients) met the inclusion criteria. When compared to saline, dexmedetomidine improved the quality of the operative field. The operative time was similar between groups. When compared to other drugs, dexmedetomidine was as effective as esmolol and remifentanil. There were no adverse incidents.Conclusion:Dexmedetomidine is beneficial in providing good visibility during functional endoscopic sinus surgery. Controlled hypotensive anaesthesia with this medicine decreases intra-operative bleeding and enhances surgical field quality.

scholarly journals Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Comparative study of Dexmedetomidine and Esmolol

2020 ◽  
Vol 24 (1) ◽  
pp. 37-49
Author(s):  
Md Shafiul Alam Shaheen ◽  
AKM Nurnobi Chowdhury ◽  
Kawsar Sardar ◽  
Mushfiqur Rahman ◽  
Sudhangshu Shekhar Biswas ◽  
...  
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sedation Score ◽  
Sinus Surgery ◽  
Effective Control ◽  
Controlled Hypotension ◽  
Fentanyl Consumption ◽  
Surgical Field ◽  
Group D

Background: Functional endoscopic sinus surgery (FESS) requires effective control of bleeding for better visibility of the operating field and reduced risk of injury to the optic nerve or the internal carotid artery. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Objectives: Our study is undertaken to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS). Methods: Sixty (60) patients 20 – 50 years of age, ASA I/II scheduled for FESS were randomly assigned to two equal groups of 30 patients each. Patients of group D received dexmedetomidine 1µg/kg over 10 min before induction of anesthesia followed by 0.4 – 0.8 µg/kg/hr infusion during maintenance and group E received esmolol loading dose 1mg/kg was infused over one min followed by 0.4 – 0.8 mg/kg/hr infusion during maintenance to maintain mean arterial blood pressure (MAP) between (55 – 65 mmHg). The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP, HR); intraoperative fentanyl consumption and total recovery from anesthesia (Aldrete’s score ≥9) were recorded. Sedation score was determined at 10, 20, 30, 40 & 60 min after tracheal extubation and time to first analgesic demand was also recorded. Results:In both group D and group E reached the desired MAP (55–65 mmHg) with no inter group difference in MAP or HR. Mean intraoperative fentanyl consumption was significantly lower in group D than group E. Recovery time to achieved Aldrete’s score ≥9 were significantly lower in group E compared with group D.The sedation score were significantly lower in group E compared with group D at 10 minutes, 20 minutes and 30 minutes postoperatively. Time to first analgesic demand was significantly longer in group D. Conclusion: The result of this study showed that both dexmedetomidine and esmolol can be used as agents for controlled hypotension and are effective in providing ideal surgical field during FESS. But dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 37-49

scholarly journals The Effectiveness of Intravenous Tranexamic Acid on Blood Loss and Surgical Time During Endoscopic Sinus Surgery: A Systematic Review

2018 ◽  
Vol 31 (2) ◽  
pp. 8-12
Author(s):  
Jona Minette E. Ligon ◽  
Natividad A. Almazan
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Endoscopic Sinus Surgery ◽  
Saline Solution ◽  
Mean Difference ◽  
Sinus Surgery ◽  
Surgical Time ◽  
Surgical Field ◽  
Standardized Mean Difference

Objective: To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).  Methods: Data Sources:  MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library. Eligibility Criteria: Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of tranexamic acid or placebo in patients undergoing ESS for CRS. Appraisal and Synthesis Methods: Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization). Results: Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (CI95 [-59.44, -42.95]) showing that the blood loss in milliliters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32 (CI95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution. The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales. Limitations:  The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients.  Conclusion: Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in this study, however results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS. Keywords: tranexamic acid, endoscopic sinus surgery, bleeding time

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