Anesthesiological Possibilities of Intraoperative Bleeding Control During Endoscopic Rhinosinusurgical Interventions

Pavlov, V. E.; Polushin, Yu. S.; Колотилов, Л. В.

doi:10.21292/2078-5658-2022-19-1-75-81

Cited by 4 publications

(2 citation statements)

References 39 publications

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“…There is no doubt that FESS procedures in the GA setting require local tissue bleeding control. [4][5][6][7]16 There are a few ways to reduce BI: hemostatic therapy, 17,18 induced hypotension, 3,7,9 administration of beta blockers, [19][20][21] or glucocorticoids. 22,23 In clinical practice, terlipressin is generally used for hepatorenal syndrome, bleeding control in abdominal and pelvic surgery, and gastrointestinal, urinary, or obstetric bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery

et al. 2023

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ObjectiveTo evaluate the use of terlipressin for intraoperative bleeding reduction in functional endoscopic sinus surgery (FESS).MethodsThis prospective, randomized, single‐center, single‐blinded cohort study included 74 cases of FESS performed under general anesthesia (GA). The patients were randomized into two groups: WT (without terlipressin, n = 39) and T (with 200 μg terlipressin, n = 35). Bleeding intensity (BI) was assessed using a 6‐point scale. Heart rate (HR), mean blood pressure (MBP), perfusion index (PI), and BI were recorded at 10, 30, and 60 min after surgery. A BI score ≥2 qualified as significant.ResultsThe T group had significantly higher MBP compared with the WT group, but HR values did not differ significantly. PI and BI scores were significantly reduced in the T group compared with the WT group. The risk of significant bleeding in the treatment group was 35.5 times lower (odds ratio [OR], 0.028; 95% confidence interval [CI], 0.006–0.138) at 30 min and 7.1 times lower (OR, 0.140; 95% CI, 0.049–0.402) at 60 min. The prognostic model for significant bleeding at 60 min showed that only terlipressin played a significant role in bleeding control (p < 0.05). The model predicted a 13.9‐fold decrease in significant bleeding risk in the T group.ConclusionLow doses (200 μg) of terlipressin reduced intraoperative bleeding without decreasing blood pressure during FESS under GA.Level of Evidence2 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

“…There is no doubt that FESS procedures in the GA setting require local tissue bleeding control 4–7,16 . There are a few ways to reduce BI: hemostatic therapy, 17,18 induced hypotension, 3,7,9 administration of beta blockers, 19–21 or glucocorticoids 22,23 .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery

et al. 2023

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The Effect of the Method of Airway Management During Endoscopic Sinus Surgery Procedures on the Intraoperative Bleeding

Pavlov

Polushin

Колотилов

et al. 2022

Vestn. anesteziol. reanimatol.

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The objective: to conduct a comparative assessment of the severity of intraoperative bleeding with different methods of airway management (using a laryngeal mask and endotracheal tube) during endoscopic rhinosinussurgical procedures.Subjects and Methods. A prospective randomized cohort single-center study of 160 cases of endoscopic rhinosinussurgical procedures under general anesthesia was conducted.Tracheal intubation (TI) was used in 79 cases (Group 1), a laryngeal mask (LM) – in 81 (Group 2). The evaluation criteria in the groups included the bleeding intensity (BI) by 6-point scale of average categories (Fromme-Boezaart Score), indicators characterizing the state of blood circulation during surgery: HR, BPsys., BPdiast., MAP, and perfusion index.Results. Significantly lower BI values were observed in Group 2 at all time points of the study (at the 10th, 30th and 60th minute of surgery). This was due both to using a laryngeal mask, and to lower HR, BPsys., BPdiast, and MAP.Conclusion. The use of a laryngeal mask for airway management during general anesthesia in endoscopic rhinosinussurgical procedures helps to reduce the intensity of surgical field bleeding.

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Terlipressin using for intraoperative bleeding reduction during endoscopic rhinosinus surgery

Arustamyan,

Pavlov,

Polushin

et al. 2024

Medicinskij sovet

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Introduction. Endoscopic rhinosinus surgery stands out for its reduced complications and marked symptomatic improvement compared to open surgical approaches. However, local bleeding challenges may compromise the efficacy of minimally invasive procedures. Exploring terlipressin’s application in endoscopic rhinosinus surgery is a promising avenue, given its mechanism of action and successful use in obstetric and other medical practices.Aim. This study aimed to assess terlipressin’s efficacy in reducing intraoperative bleeding during endoscopic rhinosinus surgical interventions under general anesthesia.Materials and methods. A prospective randomized cohort study included 170 cases of endoscopic rhinosinus surgical interventions. The BT group (n = 89) received no terlipressin, while the T group (n = 81) had 200 mcg of terlipressin during surgery. Bleeding intensity was assessed on a 6-point scale. Heart rate, blood pressure, perfusion index, and bleeding intensity were recorded at 10th, 30th, and 60th minute into the operation (study points). Bleeding intensity ≥2 points was considered significant. Results. In the T group, mean BP was significantly higher at all study points than in the BT group. Perfusion index values in the terlipressin group were significantly lower throughout. ROC analysis highlighted perfusion index’s prognostic value at 30th and 60th minutes for predicting significant bleeding. Threshold perfusion index values associated with increased bleeding probability were 4.520 at 30th minutes and 5.040 at 60th minute. Multifactorial analysis linked intraoperative terlipressin administration to a lower likelihood of significant intraoperative bleeding.Conclusion. Intravenous terlipressin (200 mcg) effectively reduces intraoperative bleeding intensity without lowering arterial pressure during endoscopic rhinosinus surgical interventions under general anesthesia.

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Anesthesiological Possibilities of Intraoperative Bleeding Control During Endoscopic Rhinosinusurgical Interventions

Cited by 4 publications

References 39 publications

Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery

Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery

The Effect of the Method of Airway Management During Endoscopic Sinus Surgery Procedures on the Intraoperative Bleeding

Terlipressin using for intraoperative bleeding reduction during endoscopic rhinosinus surgery

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