Abstract
Abstract This study conducted to evaluate and compare between topical tranexamic acid (TA) and hot saline as an alternative to local vasoconstrictors on bleeding and surgery site quality during endoscopic sinus surgery (FESS). This study was performed on 75 patients with class I and II American society of anesthesiologists (A.S.A.), scheduled for elective FESS under general anesthesia. Patients divided into three groups, each (25 patients), group A: topical tranexamic acid (1000mg diluted in 20ml normal saline) was used during surgery for packing and irrigation, group B: hot saline up to 50°C was used and group C:(control group) normal saline was used. The use of local (TA) was associated with significant decrease in estimated blood loss 214.2 ml more than local hot saline which was 216.75 and both is much better than the normal saline which was 272.66. Also (TA) and hot saline showed decrease in the duration of surgery, improve the surgical field quality and blinded surgeon satisfaction as compared with the control group. The use of local TA and local hot saline up to 50°C achieved reduction in blood loss, duration of surgery and improved surgical field quality during FESS.
Highlights
Functional endoscopic sinus surgery (FESS) is frequently used in the treatment of recalcitrant chronic rhinosinusitis (CRS) [1]
Bleeding is a common inevitable complication that results from impaired visibility of ruptured blood vessels because of excessive bleeding during surgery [2],which takes a major concern for both anesthesiologists and otolaryngologists [3]
According to the mean arterial pressure (MAP), intraoperatively there were no significant differences between the three groups (Table 3)
Summary
Functional endoscopic sinus surgery (FESS) is frequently used in the treatment of recalcitrant chronic rhinosinusitis (CRS) [1]. Bleeding during FESS can interfere with surgeon visibility, and the surgeon will have to use suction frequently and this will increase the risk of further manipulation of field, more bleeding, and longer surgery duration. It increases the risk of possible injuries of the vasculature of the eye and intracranial complications [4,5]. The most important source of bleeding during endoscopic sinus surgeries is the capillaries, and mean arterial pressure (MAP) can influence the severity of bleeding [6,7]. In an effort to reduce bleeding during FESS and improve visualization, many surgeons use techniques such as hypotensive anesthesia, elevation of the head of the bed during surgery, and administration of local vasoconstrictors [8]
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