scholarly journals Role of corticosteroids in Functional Endoscopic Sinus Surgery--a systematic review and meta-analysis

2016 ◽  
Vol 54 (1) ◽  
pp. 3-19
Author(s):  
Vishal Pundir ◽  
Jyotsna Pundir ◽  
Gillian Lancaster ◽  
Simon Baer ◽  
Paul Kirkland ◽  
...  
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Operative Outcomes ◽  
Systemic Corticosteroids ◽  
Significant Difference ◽  
Field Quality ◽  
Surgical Field

Background: The aim of our study is to systematically review the existing evidence on the role of corticosteroids in patients undergoing functional endoscopic sinus surgery (FESS). Methodology: Systematic search of MEDLINE (1950- 2014), EMBASE (1980-2014), metaRegister, Cochrane Library and ISI conference proceedings was carried out. Results: Eighteen randomised controlled trials with 1309 patients were included. Use of local and/or systemic corticosteroids with FESS was reported in four categories; operative, anaesthesia related, post-operative outcomes and risk of recurrence. Meta-analysis for operative outcomes demonstrated that, mean operative time (MD -10.70 minutes; 95% CI -15.86, -5.55; P <0.0001) and mean estimated blood loss (MD -28.32 mls; 95% CI -40.93, -15.72; P <0.0001) was significantly lower; and surgical field quality (MD -0.81; 95% CI -1.32, -0.30; P = 0.002) was significantly better in corticosteroid group. Meta-analysis showed that post-operative endoscopic scores (SMD -0.39; 95% CI -0.60, -0.17; P = 0.0004) were significantly better in corticosteroid group compared to no corticosteroid group. There was no increase in risk of sinusitis (RR 0.64; 95% CI 0.32, 1.30; P = 0.22) between use of corticosteroids and no corticosteroids; There was no significant difference in recurrence risk of chronic rhinosinusitis (CRS) in mixed population studies (RR 0.77; 95% CI 0.35, 1.70; P = 0.52) between the two groups but analysis of studies reporting on chronic rhinosinusitis with nasal polyps (CRSwNP) (RR 0.64;95% CI 0.45,0.91;P=0.01) showed significant difference in favour of the corticosteroid group. Conclusion: Pre-operative use of local and/or systemic corticosteroids in FESS, results in significantly reduced blood loss, shorter operative time and improved surgical field quality. Studies are limited on the intra-operative use of corticosteroids to reduce postoperative pain. Postoperative corticosteroids improve postoperative endoscopic scores in CRS and recurrence rates in cases of CRSwNP.

scholarly journals Role of tranexamic acid in endoscopic sinus surgery - a systematic review and meta-analysis

2013 ◽  
Vol 51 (4) ◽  
pp. 291-297
Author(s):  
V. Pundir ◽  
J. Pundir ◽  
C. Georgalas ◽  
W.J. Fokkens
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Operative Time ◽  
Meta Analysis ◽  
Sinus Surgery ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Field Quality ◽  
Surgical Field

Background: The role of tranexamic acid in patients undergoing endoscopic sinus surgery (ESS) is not clearly defined. The aim of our study is to systematically review the existing evidence on the role of tranexamic acid in patients undergoing ESS. Methodology: Systematic search of MEDLINE (1950 - 2013), EMBASE (1980 - 2013), metaRegister, Cochrane Library and ISI conference proceedings was carried out. Results: Five randomised controlled trials with 192 patients receiving tranexamic acid and 196 controls were included. Meta-analysis demonstrated that mean estimated blood loss was significantly lower, and surgical field quality was significantly better in tranexamic acid group. There was no significant difference in mean operative time between the two groups. No significant adverse effects were noted in either of the groups. Conclusion: Intra-operative use of local and systemic tranexamic acid in ESS, results in significantly reduced estimated blood loss and improved surgical field quality. There is no statistically significant difference seen in operative time and incidence of side effects. Well-conducted larger RCTs using validated objective outcome measures and reporting on minor and major complications are required.

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.

Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

2020 ◽  
pp. 194589242098067
Author(s):  
Benjamin F. Bitner ◽  
Karthik R. Prasad ◽  
Khodayar Goshtasbi ◽  
Brandyn S. Dunn ◽  
Edward C. Kuan
Keyword(s):  
Patient Satisfaction ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Complication Rates ◽  
Medical Problems ◽  
Random Effects Models ◽  
Ovid Medline ◽  
Significant Difference

Introduction Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients. Methods A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction. Results Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45–4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55–3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43–2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61–4.03, p = 0.35). Conclusion Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.

scholarly journals Intranasal Dexmedetomidine on Stress Hormones, Inflammatory Markers, and Postoperative Analgesia after Functional Endoscopic Sinus Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Chaoliang Tang ◽  
Xiang Huang ◽  
Fang Kang ◽  
Xiaoqing Chai ◽  
Song Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Inflammatory Response ◽  
Inflammatory Markers ◽  
Stress Hormones ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Body Movements ◽  
Hemodynamic Variables ◽  
Field Quality ◽  
Surgical Field

Background. A strong ongoing intraoperative stress response can cause serious adverse reactions and affect the postoperative outcome. This study evaluated the effect of intranasally administered dexmedetomidine (DEX) in combination with local anesthesia (LA) on the relief of stress and the inflammatory response during functional endoscopic sinus surgery (FESS).Methods. Sixty patients undergoing FESS were randomly allocated to receive either intranasal DEX (DEX group) or intranasal saline (Placebo group) 1 h before surgery. Stress hormones, inflammatory markers, postoperative pain relief, hemodynamic variables, blood loss, surgical field quality, body movements, and satisfaction were assessed.Results. Plasma epinephrine, norepinephrine, and blood glucose levels were significantly lower in DEX group as were the plasma IL-6 and TNF-αlevels (P<0.05). The weighted areas under the curve (AUCw) of the VAS scores were also significantly lower in DEX group at 2–12 h after surgery (P<0.001). Furthermore, hemodynamic variables, blood loss, body movements, discomfort with hemostatic stuffing, surgical field quality, and satisfaction scores of patients and surgeons were significantly better (P<0.05) in DEX group.Conclusions. Patients receiving intranasal DEX with LA for FESS exhibited less perioperative stress and inflammatory response as well as better postoperative comfort with hemostatic stuffing and analgesia.

scholarly journals Role of corticosteroids in Functional Endoscopic Sinus Surgery - a systematic review and meta-analysis

2016 ◽  
Vol 54 (1) ◽  
pp. 3-19 ◽  
Author(s):  
V. Pundir ◽  
J. Pundir ◽  
G. Lancaster ◽  
P. Kirkland ◽  
M. Cornet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Functional Endoscopic Sinus Surgery ◽  
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.

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