An Evaluation of Effect of Pterygopalatine Fossa Injection with Local Anesthetic and Adrenalin in the Control of Nasal Bleeding during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (3) ◽  
pp. 288-292 ◽  
Author(s):  
Peter-John Wormald ◽  
Theodore Athanasiadis ◽  
Guy Rees ◽  
Simon Robinson
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Pterygopalatine Fossa ◽  
Sinus Surgery ◽  
Arterial Blood ◽  
Significant Difference ◽  
Nasal Bleeding ◽  
Surgical Field ◽  
The Difference ◽  
End Tidal

Background The aim of this study was to determine the effect of pterygopalatine fossa infiltration with lidocaine and adrenalin on bleeding in the surgical field during endoscopic sinus surgery. Methods A prospective blind randomized controlled trial was performed. Fifty-five patients were randomized to receive a unilateral transoral infiltration of the pterygopalatine fossa with 2 mL of 2% lidocaine and 1:80,000 adrenalin. The operating surgeon was blinded as to which side had been infiltrated at the start of surgery. The surgical field was graded on a previously validated surgical field grading scale every 15 minutes with the side being operated on alternated every 30 minutes. The pulse, mean arterial blood pressure, and end-tidal CO2 concentration were monitored with each surgical field observation. Results At each individual time point from 30 minutes to 3.5 hours there was a significant difference in surgical grade between injected and noninjected sides in favor of the injected side (p = 0.01). The difference between surgical grades averaged across all time points was slight but significant. The injected side had an overall mean of 2.59 (SE, 0.22) compared with 2.99 (SE, 0.23) for the noninjected side. Heart rate also was found to correlate independently to surgical grade. Conclusion Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.

scholarly journals Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery?

2014 ◽  
Vol 128 (9) ◽  
pp. 814-817 ◽  
Author(s):  
C J Valdes ◽  
Y Al Badaai ◽  
M Bogado ◽  
M Samaha
Keyword(s):  
Blood Loss ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Tertiary Care ◽  
Functional Endoscopic Sinus Surgery ◽  
Pterygopalatine Fossa ◽  
Sinus Surgery ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Surgical Field

AbstractObjective:To determine the effect of pterygopalatine fossa injection with xylocaine and adrenaline on: surgical field bleeding and blood loss during functional endoscopic sinus surgery for chronic rhinosinusitis, and the duration of the procedure.Methods:A prospective, single-blinded, controlled trial was performed in a tertiary care academic centre. A total of 45 patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis, whose disease was symmetrical based on computed tomography grading, were included. A unilateral pterygopalatine fossa injection with 1 per cent xylocaine and 1:100 000 adrenaline was performed after the induction of anaesthesia. The contralateral side served as the control. The operating surgeon, who was blinded to the injected side, assessed the surgical field using a validated six-item grading system. Blood loss, blood pressure, heart rate and end-tidal carbon dioxide were recorded every 15 minutes for each side separately, and duration of surgery was noted.Results:There was no statistically significant difference in the surgical field grade between the injected and non-injected sides (p = 0.161). There were no differences in blood loss or duration of surgery.Conclusion:Pterygopalatine fossa injection prior to functional endoscopic sinus surgery did not decrease intra-operative surgical field bleeding, blood loss or duration of surgery.

Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study

2012 ◽  
Vol 126 (4) ◽  
pp. 380-384 ◽  
Author(s):  
B Saedi ◽  
M Sadeghi ◽  
S Farschi
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Controlled Trial ◽  
Nasal Packing ◽  
Sinus Surgery ◽  
Tertiary Referral Centre ◽  
Operative Care ◽  
Significant Difference ◽  
Blinded Study ◽  
Randomised Controlled

AbstractObjective:To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis.Subjects and methods:This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented.Results:There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable).Conclusion:This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.

The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (5) ◽  
pp. 514-520 ◽  
Author(s):  
Peter J. Wormald ◽  
Graham van Renen ◽  
Jonathon Perks ◽  
Janine A. Jones ◽  
Claire D. Langton-Hewer
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Total Intravenous Anesthesia ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Allergic Fungal Sinusitis ◽  
Surgical Field

Background Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Methods Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. Results The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). Conclusion In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

scholarly journals Metoprolol Significantly Improves Visual Clarity and Hemodynamic Parameters during Functional Endoscopic Sinus Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 1-8
Author(s):  
Ahmed A. Sadek ◽  
Mokhtar Mostafa ◽  
Tarek Abdel-Monem
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Study ◽  
Double Blind ◽  
Arterial Blood ◽  
Surgical Field ◽  
Group 2

Background and Objectives: The success of functional endoscopic sinus surgery (FESS) depends on the visual clarity of the surgical field, which is understudied. Controlled hypotension has many advantages for FESS including reduction in blood loss and improved quality of the surgical field. This study determined whether the use of β-blockers as a premedication could improve the operative field in FESS. Methods: Sixty patients aged from 18 to 50 years, undergoing septoplasty and FESS were included in this prospective, randomized, double-blind, placebo-controlled study. Patients were randomly assigned to receive either metoprolol (100 mg, group 1) or a placebo (a vitamin tablet, group 2) 60 min before surgery. Results: The average blood loss and surgery duration were not significantly higher in the placebo group. The surgical field was graded using the Fromme-Boezaart scale, and it was significantly clearer (p < 0.001) in metoprolol group. The mean arterial blood pressure was significantly lower in the metoprolol group after 30 min of induction until the end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in those who received metoprolol from before induction of anesthesia up to the end of surgery. Conclusion: Metoprolol significantly improves visual clarity and hemodynamics during FESS. We would recommend the use of metoprolol in FESS and septoplasty.

scholarly journals Oral clonidine: an effective adjuvant in functional endoscopic sinus surgery

2017 ◽  
Vol 6 (11) ◽  
pp. 2631 ◽  
Author(s):  
Amit Kumar Ray ◽  
Anjana Basu Ghosh Dastidar ◽  
Bani P. M. Hembrom
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Category Scale ◽  
Sinus Surgery ◽  
Nasal Surgery ◽  
Oral Clonidine ◽  
Arterial Blood ◽  
Surgical Field ◽  
Group D ◽  
Endoscopic Nasal Surgery

Background: A comparative study to evaluate the efficacy of intravenous Dexmedetomidine as a hypotensive agent in comparison to oral Clonidine in Endoscopic Nasal Surgery or Functional Endoscopic Sinus Surgery (FESS).Methods: Forty patients ASA I or II scheduled for Endoscopic Nasal Surgery were equally randomly assigned to receive either dexmedetomidine 1μg/Kg over 10 min before induction of anesthesia followed by 0.5μg/Kg/h infusion during maintenance (Group D), or oral Clonidine (Group C) 2µg/kg with minimal water 1 hour prior starting of surgery. Rescue bolus doses of Propofol (10mg/dose) were given to maintain mean arterial blood pressure (MAP) between (50-70mmHg). General anesthesia was maintained with Isoflurane 1%-2%. The surgical field was assessed using Average Category Scale. Hemodynamic variables (MAP and HR) were recorded at 10 minutes interval.Results: Both group C and group D reached the desired MAP (50-70mmHg) with no intergroup differences in HR but a statistically significant lower MAP was noticed in group C. The quality of the surgical field in the range of MAP (50-70mmHg) were 2-3 as per average category Scale with significantly lower score in Group C. Mean intraoperative propofol consumption was significantly higher in group D than C group.Conclusions: Both Dexmedetomidine or oral clonidine with isoflurane are safe agents for controlled hypotension, but oral clonidine provides lower MAP and better surgical field. Compared with Dexmedetomidine, oral clonidine offers the advantage of less consumption of propofol.

scholarly journals Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

2021 ◽  
Vol 10 (20) ◽  
pp. 4683
Author(s):  
Michał Jan Stasiowski ◽  
Izabela Szumera ◽  
Piotr Wardas ◽  
Seweryn Król ◽  
Jakub Żak ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Hemodynamic Instability ◽  
Sinus Surgery ◽  
Remifentanil Infusion ◽  
State Entropy ◽  
Anesthetic Drugs ◽  
Group A ◽  
Surgical Field ◽  
The Cost

Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.

scholarly journals A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery

2012 ◽  
Vol 50 (3) ◽  
pp. 306-310
Author(s):  
E. Akbari ◽  
C.M. Philpott ◽  
A.J. Ostry ◽  
A. Clark ◽  
A.R. Javer
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Visual Analogue Score ◽  
Mucosal Healing ◽  
Nasal Packing ◽  
Sinus Surgery ◽  
Mucosal Inflammation ◽  
Lateral Side ◽  
Double Blind ◽  
Significant Difference

Background: Middle meatal spacers are commonly used following endoscopic sinus surgery to prevent post-operative bleeding and lateralization of the middle turbinates. The effects of nasal packing on post-operative sinonasal mucosal healing remain unknown in humans. Objective: This study aims to compare the histopathalogical effects of Merocel and Merocel covered with a finger glove on mucosal healing, and patients` discomfort immediately post-operatively after endoscopic sinus surgery and at removal of the nasal packing. Methods: Thirty-seven patients with chronic rhinosinusitis undergoing bilateral endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive Merocel middle meatal spacer (MMMS) in one nostril and finger glove Merocel middle meatal spacer (FGMMS) in the contra lateral side. Patients were seen on post-operative day 6, and completed a visual analogue score reporting the post-operative discomfort from nasal packing on each side. Following the removal of nasal packing, patients indicated which side caused more discomfort on removal. Biopsies were taken from the middle turbinates and sent to a blinded pathologist who scored the level of mucosal inflammation from 0 - 4. Results: There was no statistically significant difference between MMMS and FGMMS in regards to their effect on sinonasal mucosal inflammation and discomfort post-operatively. A statistically significant difference was noted with respect to discomfort at removal with the uncovered Merocel more likely to cause discomfort when compared to the Merocel covered in a glove finger. Conclusion: MMMS and FGMMS are equivalent in the amount of sinonasal mucosal inflammation and discomfort post endoscopic sinus surgery. However, the main advantage of the FGMMS was a significant reduction in pain on removal when compared with the MMMS.

scholarly journals Influence of cigarette smoking on endoscopic sinus surgery long-term outcomes

2011 ◽  
Vol 49 (5) ◽  
pp. 577-582
Author(s):  
Anton Krzeski ◽  
Anna Galewicz ◽  
Rafal Chmielewski ◽  
Marta Kisiel
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Long Term Outcomes ◽  
Grade Classification ◽  
Significant Difference ◽  
Quality Of Life Scale ◽  
Scale Scores ◽  
The Difference

Objective: The purpose of this study was to explore the influence of smoking on long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis. Methods: The study prospectively enrolled 274 patients at the Department of Otolaryngology of the Warsaw Medical University from 1993 to 2000. All patients were diagnosed with chronic rhinosinusitis and scheduled for the endoscopic sinus surgery. We evaluated subgroups of patients with respect to bronchial asthma, allergy, aspirin triad, gastro-esophageal reflux disease and nasal septal deviation. Patients were divided into smokers and non-smokers. Patient CT scan results were recorded according to the four-grade classification system by Kennedy. Patients were observed over a period between 2 to 9 years following the surgical intervention and had their surgery revised if the severity of symptoms were at the same level or worsened. Results: Prior to endoscopic sinus surgery, 23% of smokers and 20% of non-smokers scored III or IV on the Kennedy Scale. The revision ESS was carried out in 27 patients. In this group there were 20% smokers and 7% non-smokers, with the difference being significant. There was no significant difference in the postoperative quality of life scale scores. Conclusions: The study shows that while smoking did not influence preoperative symptoms, smokers had worse postoperative outcomes.

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