Effect of Warm Saline on Bleeding during Sinus and Septum Surgery

Abstract

Objective: To assess the effect of warm saline on bleeding and surgical field visibility during endoscopic sinus surgery and septorhinoplasty. Methods: The study included 100 patients, of both males and females, aged 28-58 years, classed I and II by the American Society of Anesthesiologists (ASA), and assigned for elective functional endoscopic sinus surgery and septorhinoplasty under general endotracheal induced hypotensive anesthesia, at King Hussein Hospital, King Hussein Medical City (KHMC), Amman, Jordan, during the period Jan.2014-Feb.2015. Patients were assigned using sealed envelopes into two groups: group I (n=50): patients received warm saline of up to 48 Degree Celsius (DC) during surgery for packing and irrigation and group II (n=50): patients received room temperature normal saline of up to 20 DC, with the use of vasoconstrictors (in functional endoscopic sinus surgery and septorhinoplasty) and microdebriders (only in functional endoscopic sinus surgery). Results: Blood loss was 201.43ml in group I, while room temperature normal saline administration (group II) was correlated with 257.34 ml of blood loss (P<0.05). Conclusion: The administration of topical warm saline of up to 50 DC attained a significant decrease in blood loss and duration of surgery. It enhanced the surgical site visibility and increased the surgical satisfaction during functional endoscopic sinus surgery and septorhinoplasty.

Bleeding Control with Warm Saline Irrigation during Functional Endoscopic Sinus Surgery

“…The Boezaart score is a scale assigning a numerical value from 0 to 5, used to measure the degree of endoscopic impairment of intraoperative bleeding that occurs. 5 A similar study by Gan et al showed that the use of warm saline irrigation at 49°C was correlated with a reduced blood loss. Bleeding rate was 1.7 milliliters per minute whereas the use of saline at 18°C correlated with blood loss of 2.3 milliliters per minute.…”

“…Warm saline irrigation with a temperature of up to 50 o C can reduce of sinonasal mucosal blood from small vessels. 5 This method was first introduced by obstetricians to control postpartum hemorrhage more than 100 years ago. In the field of rhinology this method was used by Guice and Fayette in 1878 to treat epistaxis.…”

“…This study also mentions surgical satisfaction in terms of visibility of the surgical view related to decreased intraoperative bleeding. The proportion of surgeons who were satisfied in group I was 88% compared to group II at 32% 5. Shehata et al Study reported a duration of surgery of 75.92 ± 7.64 minutes in group A, 74.22 ± 7.54 minutes in group B and 98.54 minutes in group C (P = 0.0002).…”

“…Another advantage of warm saline irrigation is that it can keep the endoscopic lens clear. 4,5 The aim of this evidence-based case report is to know the effectiveness of warm saline irrigation as mucosal bleeding control during FESS.…”

Hot saline irrigation for haemostasis in functional endoscopic sinus surgery: a systematic review and meta-analysis

“…8 Hot saline irrigation has previously been used as treatment in epistaxis, 8 postadenoidectomy haemorrhage, 9 post-partum haemorrhage 10 and more recently the technique has been utilised in FESS. [11][12][13] The haemostatic mechanism of hot saline irrigation is still poorly understood. However, Stangerup and Thomsen found that rabbit nasal mucosa exposed to water at a temperature of 50°C led to mucosal oedema and dilatation of capillary vessels without any detrimental toxic effects or necrosis.…”