Effect of local desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple-blinded clinical trial

Jahanshahi, Javaneh; Tayebi, Elham; Hashemian, Farnaz; Bakhshaei, Mohammad Hossein; Ahmadi, Mohammad Saeid; Seifrabiei, Mohammad Ali

doi:10.1007/s00405-019-05435-3

Cited by 12 publications

(30 citation statements)

References 10 publications

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“…As for LD‐DDAVP, there were no significant intervention effects on the volume of intra‐operative bleeding or clean surgical field rates in endoscopic sinus surgery (effect size d: 0.02, 95% CI: −0.42–0.45 for blood loss; RR: 1.34, 95% CI: 0.86–2.09 for clean surgical field). This finding is contrast to the results of previous trials 9,10 . One possible explanation could be that the lower degree of chronic rhinosinusitis in the previous trials (fewer participants with CRwNP or high points of Lund‐Mackay score) has caused the substantial bleeding in FESS.…”

Section: Discussioncontrasting

confidence: 85%

“…Several randomized clinical trials (RCTs) have been conducted on patients undergoing various types of surgeries. Two clinical studies have evaluated the effects of nasal spray on FESS 9,10 . An initial RCT demonstrated that premedication with low dose (20 μg) DDAVP nasal spray significantly reduces bleeding and improves the quality of the surgical field 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Two clinical studies have evaluated the effects of nasal spray on FESS 9,10 . An initial RCT demonstrated that premedication with low dose (20 μg) DDAVP nasal spray significantly reduces bleeding and improves the quality of the surgical field 9 . In the second RCT, Safaeian et al showed similar findings after premedication with DDAVP nasal spray (20 μg) during endoscopic sinus surgery 10 .…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 10 An initial RCT demonstrated that premedication with low dose (20 μg) DDAVP nasal spray significantly reduces bleeding and improves the quality of the surgical field. 9 In the second RCT, Safaeian et al showed similar findings after premedication with DDAVP nasal spray (20 μg) during endoscopic sinus surgery. 10 Nonetheless, there are several concerns regarding the methodology of these studies.…”

Section: Introductionmentioning

confidence: 99%

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Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial

Akbarpour

Jalali

Akbari

et al. 2022

Laryngoscope Investig Oto

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Background This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in Functional Endoscopic Sinus Surgery (FESS). Material and methods In a randomized clinical trial, patients referred for FESS to treat their bilateral chronic rhinosinusitis were recruited. The participants were adults (≥18 years). They were randomly assigned (1:1:1) to receive low‐dose (20 μg) or high‐dose (40 μg) intranasal desmopressin (DDAVP) or placebo 60 min before the induction of general anesthesia. Standard FESS was performed by the same surgeon. The primary outcomes were volume of intraoperative bleeding and the quality of surgical field. Clean surgical field was defined as a score ≤2 on the Boezaart grading system. Results A total of 120 patients were included on an intention‐to‐treat basis (mean age: 41.0 years; 40 women, 80 men). There were no significant differences in primary outcomes between low‐dose DDAVP and placebo. As for the volume of blood loss, however, there was a significant difference between high‐dose DDAVP and placebo (mean difference: 29.6 ml; adjusted Cohen's d: −1.02; p < .001). Also, in the high‐dose DDAVP, the probability of having a good surgical field over time was about two times higher than in the placebo group (RRs for first and second surgical sides: 1.89 and 2.18). The number needed to treat for the two time points was 1.6 and 1.3, respectively. Conclusion The present study showed that the use of desmopressin at a dose of 40 μg 1 h before surgery can reduce bleeding and improve the quality of the surgical field. Further studies are recommended to be able to generalize these findings to other ENT surgeries. Level of evidence 1b.

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Section: Discussioncontrasting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial

Akbarpour

Jalali

Akbari

et al. 2022

Laryngoscope Investig Oto

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“…20 Another study included 60 patients with CRS. 21 Thirty patients of the intervention group were given three pledgets soaked in 5% TA and 0.5% phenylephrine for 10 minutes in both nostrils before surgery. In the control group 30 patients were given only 0.5% phenylephrine by similar technique.…”

Section: Discussionmentioning

confidence: 99%

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

Padhy

Narayanaswamy

2019

BJOHNS

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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.

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The Effect of Desmopressin Intraoperatively on Hemorrhage During the Rhinoplasty Surgery

Youssefy

Ghabasiah

Heidari

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Effect of local desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple-blinded clinical trial

Cited by 12 publications

References 10 publications

Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial

Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial

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

The Effect of Desmopressin Intraoperatively on Hemorrhage During the Rhinoplasty Surgery

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