Bleeding control in endoscopic sinus surgery: a systematic review of the literature

Valiente, A Rodriguez; Fidalgo, A Roldan; Ortega, Debora M.

doi:10.4193/rhin12.048

Cited by 22 publications

(25 citation statements)

References 24 publications

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“…such as reverse Trendelenburg positioning, topical decongestants, infiltration of local anesthetics, heart rate control, and manipulation of general anesthesia have been shown to reduce intraoperative blood loss and improve visualization of the surgical field (15) . Recently Pundir et al also published a meta-analysis on the effect of intra-operative use of local and systemic tranexamic acid in resulting in significantly reduced estimated blood loss and improved surgical field quality (16) .…”

Section: Numerous Other Interventions To Optimize Surgical Visibilitymentioning

confidence: 99%

Sinus surgery: optimal surgery, optimal outcome?

Fokkens¹

2016

Rhin

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Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness irrespective of BMI. The OSAS was also not correlated with the severity of rhinosinusitis, SNOT-20 score, nasal obstruction score, endoscopic score, CT score, and smell function. It could be an argument for FESS although unfortunately the authors did not report whether the OSAS decreased after FESS (1) . In position papers and guidelines like EPOS2012 or ICON it is suggested to perform sinus surgery when "optimal medical treatment" does not result in relevant reduction of symptoms (2,3) . When surgery is considered, usually a minimum period of medical treatment of 3 months is suggested unless the symptoms are very severe, e.g. in massive nasal polyps or when complications, like mucoceles (tend to) occur. In a recent Cochrane review, however, the evidence does not show that surgery is better than medical treatment in terms of patient-reported symptom scores and quality of life measurements (4) . On the other hand there are indications that early surgery (< 12 months after start of the symptoms) improves the outcomes (5,6) . Recent cluster analysis performed in patients eligible for surgery who choose to be operated or not (based on personal preference, not randomization) indicated that based on age, SNOT-22 score, and lost productivity over 90 days patient can be clustered in groups that benefit more from surgery than others (7,8) . When deciding whether FESS is the best option, there is a lot of debate which outcomes are most relevant to measure. In this issue of the Journal Hopkins et. al. report on a survey in which patients and practitioners were asked to list the 3 outcomes from treatments they considered to be most important (9) . Interestingly, 73% suggested symptoms of CRS to be the most important and only 9% concerned quality of life, 4% reducing the need for further treatment and 4% side effects of treatment. The questionswere asked very open: "What results from treatments are most important to you (for patients)?" and "what are the most important outcomes that you want from treatments for people with rhinosinusitis (for health professionals". It would be interes-the hard work of many of us has tremendously increased our knowledge to better inform the patient when FESS is a good option to treat CRS we also still have a lot to learn and I hope to inspire all of you to contribute to the development of our common knowledge.

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Section: Numerous Other Interventions To Optimize Surgical Visibilitymentioning

confidence: 99%

Sinus surgery: optimal surgery, optimal outcome?

Fokkens¹

2016

Rhin

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“…In endoscopic surgery, even a small amount of bleeding interferes with the visual field; therefore, a reduction in bleeding is essential to facilitate a smooth and successful procedure. However, the reduced blood loss provided by remifentanil in endoscopic surgery has only been reported for otolaryngology procedures such as rhinoplasty and sinus surgery (Ha et al 2014;Kosucu et al 2014;Cardesin et al 2015;Rodriguez Valiente et al 2013). It is unknown whether there is a relationship between the use of intraoperative remifentanil and blood loss in other types of endoscopic surgery such as endoscopic body surface surgery.…”

Section: Introductionmentioning

confidence: 99%

Protective effect of remifentanil on blood loss in endoscopic subcutaneous mastectomy: a retrospective study

Yamaguchi

Nakamura

Kobayashi

et al. 2018

Ain-Shams J Anesthesiol

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Background: Remifentanil decreases blood loss during spinal surgery, rhinoplasty, and endoscopic sinus surgery. However, there are no reports regarding its effect on intraoperative blood loss during endoscopic body surface surgery. The present study aimed to investigate the effect of intraoperative remifentanil on blood loss during endoscopic subcutaneous mastectomy. Methods: In this single-center, retrospective observational study conducted from August 2005 to June 2010, 443 patients who underwent either endoscopic subcutaneous partial mastectomy or quadrantectomy were included (n = 231 and 212, respectively). Patients were categorized into the remifentanil and non-remifentanil groups (n = 154 and 289, respectively) based on intraoperative use of remifentanil. We compared the amount of blood loss between the remifentanil and non-remifentanil groups. Results: Blood loss was significantly smaller in the remifentanil group than in the non-remifentanil group in patients undergoing partial mastectomy (median [25%, 75%], 60 [30, 94] vs. 90 [50, 165] ml, P < 0.001) and quadrantectomy (90 [30, 163] vs. 140 [74, 220] ml, P = 0.001). Conclusions: Intraoperative bleeding was significantly smaller in patients receiving remifentanil than that in those not receiving remifentanil during endoscopic subcutaneous mastectomies.

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“…The endoscopic approach is a minimally invasive procedure that has been associated with higher rates of total disease resection, low risk of postoperative complications, and reduced hospital length of stay . However, surgical field visualization is dependent on achieving adequate intraoperative hemostasis . As a result, many studies have focused on identifying perioperative techniques to reduce intraoperative blood loss.…”

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confidence: 99%

“…Epinephrine is an adrenergic agonist widely used in ESS due to its vasoconstrictive properties . Although epinephrine is administered locally for endonasal procedures, research has shown that even localized intranasal epinephrine application and injection can still lead to systemic absorption .…”

mentioning

confidence: 99%

“…[5][6][7] Epinephrine is an adrenergic agonist widely used in ESS due to its vasoconstrictive properties. 4,8 Although epinephrine is administered locally for endonasal procedures, research has shown that even localized intranasal epinephrine application and injection can still lead to systemic absorption. 9 This phenomenon has been linked to undesired systemic cardiovascular side effects, with recent studies indicating that intranasal epinephrine administration may induce hemodynamic dysregulation, resulting in hypertension and tachycardia.…”

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confidence: 99%

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Real‐time hemodynamic effects of 1:100,000 and 1:200,000 injectable epinephrine and placement of topical 1:1000 epinephrine pledgets in patients undergoing endoscopic sinus and skull‐base surgery: a randomized, prospective study

Ahmed

Choi

et al. 2019

Int Forum Allergy Rhinol

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Background Intranasal injection of epinephrine and placement of topical epinephrine pledgets are methods to improve visualization during endoscopic sinonasal surgery. Studies comparing the hemodynamic effects of these vasoconstrictors using intraoperative arterial line monitoring are lacking. Methods Twenty‐eight patients undergoing endoscopic skull‐base surgery were enrolled in a prospective, randomized study. Patients were randomized to have either 2 mL of 1:100,000 or 2 mL of 1:200,000 epinephrine injected intranasally. Hemodynamic parameters, including pulse, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were collected using intraoperative arterial line monitoring for 5 minutes. Afterward, 1:1000 topical epinephrine‐soaked pledgets were placed in both groups, and the same parameters were collected for another 5 minutes. Results There was no statistical difference in change in pulse, SBP, DBP, and MAP between the 1:100,000 and 1:200,000 epinephrine groups. However, epinephrine injections did cause an increase in all hemodynamic parameters when compared with baseline (p < 0.05). Topical epinephrine pledgets placed after injection of epinephrine did not have any significant hemodynamic effects, except for 2 of 28 patients who had a >75‐mmHg increase in SBP. No preoperative characteristics were identified that predicted sensitivity to epinephrine. Conclusion There is no statistical difference in changes in hemodynamic parameters between injecting epinephrine 1:100,000 compared with 1:200,000 during endoscopic sinonasal surgery. In a subset of patients, placement of topical 1:1000 epinephrine pledgets had significant hemodynamic elevation requiring intervention and thus should be used judiciously depending on patient comorbidities.

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Bleeding control in endoscopic sinus surgery: a systematic review of the literature

Cited by 22 publications

References 24 publications

Sinus surgery: optimal surgery, optimal outcome?

Sinus surgery: optimal surgery, optimal outcome?

Protective effect of remifentanil on blood loss in endoscopic subcutaneous mastectomy: a retrospective study

Real‐time hemodynamic effects of 1:100,000 and 1:200,000 injectable epinephrine and placement of topical 1:1000 epinephrine pledgets in patients undergoing endoscopic sinus and skull‐base surgery: a randomized, prospective study

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