Field In Endoscopic Sinus Surgery Research Articles

Impact of Intravenous Tranexamic Acid on Intraoperative Bleeding during Endoscopic Sinus Surgery

Introduction
 Bleeding during surgery is one of the most important concerns in endoscopic sinus surgery (ESS). The study conducted was aimed at assessing the efficacy of tranexamic acid on bleeding during endoscopic sinus surgeries. 
 Materials and Methods
 A total of 30 patients were enrolled for the study. Lund and Mackay symptom score and radiological staging was used to compare clinical profile. The surgical field was assessed by the surgeon who was blinded, i.e., was not aware of which set of patients were receiving the drug. Boezaart and van de Merwe grading scale was used to assess the intraoperative surgical field. Both groups were selected so as to comprise of patients having similar clinical profile in terms of symptom score and radiological staging. 
 Results
 In the arm receiving tranexamic acid, blood loss was found to be less and statistically significant (p=0.0157). The surgical field in endoscopic sinus surgery is more important factor in determining the completion and satisfactory outcomes of the surgery. Significantly high percentage (80%) of patients who were given the drug had a grade 2 scale when compared to (26.7%) in patients not receiving the drug. The difference in score in surgical field grading scale was also statistically significant (p=0.0034). The reported side effects of tranexamic acid mainly include nausea, vomiting, and possibly arterial or venous thrombosis, however none of the patients in our study had any side effects of the drug. Post-operative stay in the hospital was uneventful. 
 Conclusion
 Intravenous Tranexamic acid reduced the intraoperative bleeding significantly and was useful in providing a better operative field.

Optimization of the Surgical Field in Endoscopic Sinus Surgery: an Evidence-Based Approach.

The advent of endoscopic sinus surgery (ESS) has enabled the development of minimally invasive surgical procedures in Rhinology. However, proficiency with ESS techniques can still be hampered by poorly controlled bleeding limiting visibility of the surgical field (VSF). This can lead to increased operating time and, more importantly, increased risk of major and minor complications. To optimize the VSF and mitigate the risk of complications, many strategies have been explored. This is a narrative review of the relative risks and benefits of pre- and intra-operative interventions aimed at optimizing intraoperative conditions during ESS. The value of these interventions is determined based on their impact on intraoperative blood loss, time of surgery, and the VSF, and weighed against their adverse event profile. This review provides a comprehensive overview of the evidence relating to the safety and efficacy of interventions used to improve intraoperative conditions during ESS.

Contemporary decongestant practices of Canadian otolaryngologists for endoscopic sinus surgery

BackgroundCocaine has traditionally been the topical decongestant most frequently used for visualization of the surgical field in Endoscopic Sinus Surgery (ESS). Alternatives include xylometazoline, oxymetazoline, and epinephrine. The understanding of the safety profile of each agent is changing, as are the practices of Otolaryngologists-Head & Neck Surgeons. The objective of this study is to determine decongestant use practices in ESS across Canada, which has not previously been studied.MethodsA cross-sectional survey design using a 24-item electronic questionnaire was distributed to actively practicing members of the Canadian Society of Otolaryngology-Head and Neck Surgery via email. A French translated version of the survey was also available. Questions explored the respondents’ demographics and decongestion practices for ESS.ResultsNinety-six surveys from otolaryngologists practicing in Canada were completed (19% response rate). The average time in practice was 16.5 years (range 1–50 years, SD 12.0 years). Twenty-six (27%) of respondents use some form of cocaine solution for topical decongestion in ESS. Over a total of over 1500 combined practice-years, eight respondents (8%) personally experienced an adverse event that could be attributed to cocaine, including two mortalities. One cardiac even was directly attributable to the patients’ use of recreational cocaine in the immediate pre-operative period.ConclusionThe popularity of cocaine for topical decongestion in ESS in present-day Canada is less than in surveys from other countries. However, there are few reported adverse events with long-term consequences that are attributable to intraoperative cocaine. Considering the beneficial effects of cocaine for visualization and pain control, this change in practice warrants further investigation.

Clonidine or remifentanil for adequate surgical conditions in patients undergoing endoscopic sinus surgery: a randomized study.

BackgroundDeliberate hypotension is one way to achieve a bloodless surgical field in endoscopic sinus surgery (ESS). We compared two anaesthesia regimens to induce deliberate hypotension and attempted to determine the most efficient one.MethodsFifty-nine patients undergoing ESS were minimized into two groups. In the CLO group, patients received I.V. sufentanil 0.15 µg/kg together with I.V. clonidine 2–3 µg/kg. In the REMI group, patients received remifentanil at a rate of up to 1 µg/kg/min. Fromme scores were collected 15 min after the incision and at the end of the procedure. Mean arterial pressure readings (MAP), heart rate readings, time to eyes opening, time to extubation, pain scores, analgesic requirements, and oxygen needs were collected and compared.ResultsThere were no significant differences in Fromme scores between the two groups. The averaged MAP from 15 min to the end of the procedure was significantly lower in the REMI group; these patients also received more ephedrine. Significantly fewer patients in the CLO group needed oxygen therapy to keep their Pulse Oximeter Oxygen Saturation within 3% of their preoperative values. Patients in this group also needed less piritramide in the recovery room, and their pain scores were lower at discharge from the recovery room.DiscussionAlthough both anaesthesia regimens offered a similar quality of surgical field, this study suggests that clonidine had a better average safety profile. Furthermore, patients who received this regimen required fewer painkillers immediately after surgery.

Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in endoscopic sinus surgery.

BackgroundIn endoscopic sinus surgery, visualization of the surgical field is a major concern, as surgical bleeding is the cause of many complications. The purpose of this study was to compare the effects of dexmedetomidine and remifentanil on the visualization of the surgical field in endoscopic sinus surgery.MethodsForty-three patients were prospectively enrolled and randomly allocated to the dexmedetomidine or remifentanil group and general anesthesia was induced and maintained using a propofol target-controlled infusion. In the dexmedetomidine group, dexmedetomidine was loaded for 5 min and a continuous infusion was administered. In the remifentanil group, a remifentanil target-controlled infusion was used. After completion of the operation, the satisfaction with the visualization of the surgical field was assessed on a numeric rating scale, from 0 (= worst) to 10 (= best). The mean blood pressure, heart rate, recovery profiles, and postoperative pain score were recorded.ResultsSatisfaction score for visualization by numeric rating scale was not significantly different between the two groups (P = 0.95). There were no differences in the mean blood pressure and heart rate. The extubation time was significantly shorter in the dexmedetomidine group (8.4 ± 1.8 min) than in the remifentanil group (11.9 ± 5.4 min) (P = 0.04). Except for the extubation time, the recovery profiles of the two groups were comparable.ConclusionsContinuous infusions of dexmedetomidine provide a similar visualization of the surgical field and hemodynamic stability as remifentanil target-controlled infusions in patients undergoing endoscopic sinus surgery.

Induced Hypotension for Nasal Surgery: Remifentanil versus Esmolol

Objectives: Compare the efficiency and safety of using remifentanil versus esmolol infusion for induction and maintenance of controlled hypotension. The study evaluates this effect on the quality and dryness of the operative field in endoscopic sinus surgery (FESS). Design: Prospective, randomized, patient- and observer-blinded study. Methods: Thirty patients undergoing FESS were randomly assigned to receive either remifentanil or esmolol for inducing controlled hypotension. The same surgeon blinded to the hypotensive agent used and hemodynamic variables performed all operations. He used a six point scale of 0-5 to assess the surgical field (0= bloodless and 5= uncontrolled bleeding). Results: Controlled hypotension was achieved at the target mean pressure of 50-55 mmHg for both remifentanil and esmolol groups. There were no statistical differences between the groups in duration of anesthesia, duration of hypotension, hemodynamic changes, or PaCo2 or PaO2 measurements. Category scale values for surgical conditions were ideal in both groups: 2.61±0.32 in the remifentanil group and 2.48±0.21 in the esmolol group, with no significant difference between the two groups. Conclusions: Both remifentanil and esmolol infusion provide consistent and sustained controlled hypotension, and both are effective in providing a dry surgical field during functional endoscopic sinus surgery.

Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery

Study Objective: To determine if moderate controlled hypotension can improve the dryness of the surgical field in endoscopic sinus surgery. Study Design: Randomized, prospective study. Setting: University-affiliated hospital. Patients: 32 ASA physical status I and II adult patients undergoing endoscopic sinus surgery. Interventions: All patients were premedicated orally with chlorazepate. Patients in Group H received 12.5 mg captopril orally prior to surgery. Anesthesia was provided using an intravenous (IV) technique supplemented with nitrous oxide (N 2O); anesthesia was maintained with boluses of 2 μg/kg fentanyl and a propofol infusion at rates between 3 and 9 mg/kg/h at the discretion of the anesthetist. In Group H, sodium nitroprusside was infused at a rate of 1 to 2.5 μg/kg/min to maintain moderate controlled hypotension with mean blood pressure of 65 to 75 mm Hg. Measurements and Main Results: Arterial blood pressure was assessed via the radial artery. Readings were recorded prior to intubation, immediately after intubation, at the start of surgery, then at 5, 15, 30, 45, and 60 minutes intraoperatively, and at the end of surgery. Intraoperative blood loss, dryness of the surgical field, adrenocorticotropic (ACTH) hormone, arginin-vasopressin (AVP), cortisol, and the preoperative and postoperative psychomotoric function were examined. At the start of surgery and thereafter, MAP increased in Group N but not in Group H. Throughout surgery, MAP was significantly lower in Group H than in Group N. Blood loss, dryness of the surgical field, ACTH, AVP, and cortisol levels, and psychomotoric function were not significantly different between the groups. Conclusion: Intravenous anesthesia supplemented with N 2 is as effective as moderate controlled hypotension when blood loss, visibility in the surgical field, ACTH, AVP, and cortisol are examined.