EVALUATION OF ACUTE PAIN SYNDROME IN PATIENTS AFTER SEPTOPLASTY AND VARIOUS ANESTHETIC STRATEGIES

The aim of the study was to evaluate acute pain syndrome in patients after septoplasty and various strategies of general anesthesia. Materials and Methods. All patients received local infiltration anesthesia with 2 % procaine solution. In group 1 (n=105), a 2 % solution of promedol and 60 mg of ketorolac were used as evening premedication; in group 2 (n=108), fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine and metoclopramide were used; in group 3 (n=78), atracuria besylate, sodium thiopental, nitrous oxide and halothane were used. In groups 2 and 3, 100 mg of ketoprofen was injected intramuscularly in the evening of the postsurgical day. Anterior tamponade was carried out with foam tampons. The tamponade was removed on the 2nd day in the groups 1 and 2, and in group 3 it was removed one day after the surgery. Pain syndrome was assessed in 1, 3, and 6 hours, 1 and 2 days after surgery using a visual analogue scale (VAS), a verbal “lightning” scale (VLS), and a numeric rating scale (NRS). Pain was also assessed 1 hour after tamponade removal. Results. At all stages of the examination (except Day 2), the pain syndrome was less pronounced in group 2. A day after surgery, the patients of group 3 had more severe pain if compared with those of other groups. Conclusion. During septoplasty, the least painful reaction is provoked by the general anesthesia scheme as used in group 3: fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine and metoclopramide. In case of nasal tamponade after septoplasty, the tampons should be removed on the 2nd day after surgery. Key words: septoplasty, anesthesia, analogue scales, pain. Цель исследования заключалась в оценке острого болевого синдрома у пациентов после септопластики при применении различных тактик общей анестезии. Материалы и методы. Ко всем пациентам применяли местную инфильтрационную анестезию 2 % раствором прокаина. В 1-й группе (105 чел.) использовали премедикацию 2 % раствором промедола и 60 мг кеторолака вечером, во 2-й группе (108 чел.) – фентанил, пропофол, цисатракурия безилат, транексамовую кислоту, атропин и метоклопрамид, в 3-й группе (78 чел.) – атракурия безилат, тиопентал натрия, закись азота и галотан. Во 2-й и 3-й группах вечером в день операции внутримышечно вводили 100 мг кетопрофена. Переднюю тампонаду осуществляли поролоновыми тампонами в резиновой перчатке. В 1-й и 2-й группах тампонаду удаляли на 2-й день, а в 3-й группе – через сутки после операции. Болевой синдром оценивали через 1, 3 и 6 ч, 1 и 2 сут после операции с помощью визуально-аналоговой шкалы, вербальной шкалы-«молнии», цифровой рейтинговой шкалы. После удаления тампонов боль оценивали через 1 ч. Результаты. На всех этапах обследования, кроме 2-го дня, болевой синдром был менее выражен во 2-й группе. Через сутки у пациентов 3-й группы боль была выше, чем в остальных. Выводы. При проведении септопластики наименьшую болевую реакцию провоцирует схема общей анестезии, примененная в 3-й группе: фентанил, пропофол, цисатракурия безилат, транексамовая кислота, атропин и метоклопрамид. В условиях тампонады носа после септопластики тампоны необходимо удалять на 2-й день после операции. Ключевые слова: септопластика, анестезия, аналоговые шкалы, боль.

Epistaxis etiology and treatment

Epistaxis occurs in approximately 60% of the general population. Every tenthperson requires treatment in a hospital setting. Epistaxis occurs in all age groups,reaching its peak in children around 10 years of age and in adults around 80years of age. The frequency and intensity of epistaxis are anatomically based onnumerous vascular connections. The cause of epistaxis in most cases can bedetermined on the basis of a detailed history and physical examination. Thereare a number of treatments available for nose bleeds. From widely availablemethods such as nasal tamponade to more advanced endovascular procedures.

Combined method of stopping nasal hemorrage

Topicality: Nasal hemorrhage (NH) is one of the most common reasons for patients to seek emergency otorhinolaryngological care. Due to the significant increase in cardiovascular disease, endovascular interventions, as well as the wide use of anticoagulant and disaggregating therapy (in most cases, long courses or even lifelong), cases of recurrent NH have become more frequent. In reference, there is a problem of modification of local methods of stopping NH in patients who receive the above therapy for a long time, because intervention in the hemostasis system in this group of patients causes certain difficulties. Aim of the study: The development of an anatomical intranasal tampon that allows you to combine several types of effects on the bleeding area is an extremely important task. Materials and methods: We have proposed a combined method of stopping NH, which includes the use of a two-chambered hydraulic tampon of our self design in combination with gel “Nosochem” and thermal exposure. Results: The proposed method of stopping NH was used in 24 patients, the average duration of nasal tamponade was 52.4±5.3 hours. In 23 (95.8%) patients, the proposed method provided effective stoppage of NH. Conclusions. The proposed hydrotampon in combination with “Nosochem” gel and local thermal exposure is a simple, effective and convenient to use combined method of stopping NH, which can be used as a method of choice for NH in patients who take anticoagulants and disaggregants for a long time.

The endonasal patient reference tracker: a novel solution for accurate noninvasive electromagnetic neuronavigation

OBJECTIVEElectromagnetic (EM) navigation provides the advantages of continuous guidance and tip-tracking of instruments. The current solutions for patient reference trackers are suboptimal, as they are either invasively screwed to the bone or less accurate if attached to the skin. The authors present a novel EM reference method with the tracker rigidly but not invasively positioned inside the nasal cavity.METHODSThe nasal tracker (NT) consists of the EM coil array of the AxiEM tracker plugged into a nasal tamponade, which is then inserted into the inferior nasal meatus. Initially, a proof-of-concept study was performed on two cadaveric skull bases. The stability of the NT was assessed in simulated surgical situations, for example, prone, supine, and lateral patient positioning and skin traction. A deviation ≤ 2 mm was judged sufficiently accurate for clinical trial. Thus, a feasibility study was performed in the clinical setting. Positional changes of the NT and a standard skin-adhesive tracker (ST) relative to a ground-truth reference tracker were recorded throughout routine surgical procedures. The accuracy of the NT and ST was compared at different stages of surgery.RESULTSEx vivo, the NT proved to be highly stable in all simulated surgical situations (median deviation 0.4 mm, range 0.0–2.0 mm). In 13 routine clinical cases, the NT was significantly more stable than the ST (median deviation at procedure end 1.3 mm, range 0.5–3.0 mm vs 4.0 mm, range 1.2–11.2 mm, p = 0.002). The loss of accuracy of the ST was highest during draping and flap fixation.CONCLUSIONSApplication of the EM endonasal patient tracker was found to be feasible with high procedural stability ex vivo as well as in the clinical setting. This innovation combines the advantages of high precision and noninvasiveness and may, in the future, enhance EM navigation for neurosurgery.

Proptosis following nasal tamponade

A fracture of the lamina papyracea as a result of nasal packing, though plausible is undocumented. A case is presented, with a cautionary note to avoid the use of excessive pressure in packs and balloons when attempting to control epistaxis in elderly patients.