Desmopressin nasal spray reduces blood loss and improves the quality of the surgical field during functional endoscopic sinus surgery

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.

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Effect of local desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple-blinded clinical trial

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-019-05435-3 ◽

2019 ◽

Vol 276 (7) ◽

pp. 1995-1999

Author(s):

Javaneh Jahanshahi ◽

Elham Tayebi ◽

Farnaz Hashemian ◽

Mohammad Hossein Bakhshaei ◽

Mohammad Saeid Ahmadi ◽

...

Keyword(s):

Clinical Trial ◽

Blood Loss ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Intraoperative Blood Loss ◽

Surgical Field

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

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i1.45340 ◽

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

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Effect of Topical Tranexamic Acid on Bleeding and Quality of Surgical Field during Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: A Triple Blind Randomized Clinical Trial

PLoS ONE ◽

10.1371/journal.pone.0104477 ◽

2014 ◽

Vol 9 (8) ◽

pp. e104477 ◽

Cited By ~ 21

Author(s):

Javaneh Jahanshahi ◽

Farnaz Hashemian ◽

Sara Pazira ◽

Mohammad Hossein Bakhshaei ◽

Farhad Farahani ◽

...

Keyword(s):

Clinical Trial ◽

Tranexamic Acid ◽

Randomized Clinical Trial ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Surgical Field ◽

Topical Tranexamic Acid

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The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial

Journal of Anesthesia ◽

10.1007/s00540-011-1157-9 ◽

2011 ◽

Vol 25 (4) ◽

pp. 614-617 ◽

Cited By ~ 15

Author(s):

Masood Mohseni ◽

Amin Ebneshahidi

Keyword(s):

Clinical Trial ◽

Blood Loss ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Controlled Clinical Trial ◽

Oral Clonidine ◽

Surgical Field

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215115001334 ◽

2015 ◽

Vol 129 (S3) ◽

pp. S8-S13 ◽

Cited By ~ 10

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.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001790 ◽

2014 ◽

Vol 128 (9) ◽

pp. 814-817 ◽

Cited By ~ 10

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.

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