This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: To define anatomical variations associated with arterial blood supply of the nose which has clinical implications on the management of different disorders, especially intractable posterior epistaxis. Study Design: Case series. Methods: Selective angiography of external and internal carotid arteries of 100 patients scheduled for routine angiography was done. Results: Different anatomical variations were documented. The ophthalmic artery can arise from the middle meningeal artery in 1% while ethmoidal arteries can be absent in 5%. The maxillary artery courses as 2 loops in the pterygopalatine fossa in 64% of cases where the descending palatine artery originates before the first loop or on its top so that caution is needed in controlling epistaxis. The sphenopalatine artery has different patterns of branching and may have more than 2 branches in 18% of cases. In 19% of cases, there is cross-circulation between both sides through the nasal blood supply. Conclusion: Angiographic study of the nose is a very helpful tool for accurate knowledge of anatomical variations of the arteries with a tremendous effect on our surgical approaches and techniques for the management of different diseases in the nasal region, especially intractable posterior epistaxis.

Background & Purpose The effects of desflurane and sevoflurane, two commonly used inhalation anesthetics for the maintenance of general anesthesia, on peri- and postoperative bleeding is a focus of interest. This study conductd to evaluating that; Sevoflurane can cause bleeding tendencies more than Isoflurane anesthesia or not? Study design Prospective, randomized comparative study. Setting Ain shams university hospitals. Subjects We included 40 tonsillectomy patients (age from 2 – 12 years old), and classified them according to the anesthetic drug used into 2 independent groups: Isoflurane group (20 patients) and Sevoflurane group (20 patients). Methods All patients were subjected to full history taking, oral cavity examination, anterior rhinoscopy nasal examination, basic laboratory studies for bleeding tendencies (e.g. platelets and INR), adenoidal-tonsillectomy operational data (including operative time calculation), bleeding outcomes (blood loss and packs of blood transfusion) will be recorded, and half of the cases will be anesthetized with sevoflurane and another half with isoflurane. Results In the studied population, the mean age of all patients was (7.1 ± 2.7) years, with (57.5%) of patients were males; while (42.5%) were females. Regarding bleeding outcome data; the average blood loss of all patients was (15.5 ± 3.7) cc, and the average packs used were (4.2 ± 1.1). We found a significant decrease in operative time in the Isoflurane group; compared to the Sevoflurane group (p = 0.0017). Regarding Bleeding outcome data; we found, a significant decrease in blood loss, in the Isoflurane group; compared to the Sevoflurane group (p = 0.00014), and a significant decrease in the number of packs used, in Isoflurane group; compared to Sevoflurane group (p = 0.0018). Conclusion To conclude, anesthesia with isoflurane can lead to a lower amount of intraoperative bleeding compared with sevoflurane. Therefore, isoflurane may be preferred as an inhalational agent for the maintenance of general anesthesia during tonsillectomy and adenoidectomy operations.

No abstract