Hemostasis in endoscopic sinus and skull base surgery

Abstract

Purpose of reviewBleeding during endoscopic endonasal procedures can quickly obscure critical anatomic landmarks. This increases both the difficulty of the surgical procedure and the risk of complications faced by the patient. As the indications for surgical management of sinonasal pathology grow, it is important to review techniques to minimize bleeding and facilitate safe surgery. Recent findingsEvidence continues to accumulate for best practices in the surgical management of sinonasal disease. Recently, international guidelines have attempted to summarize this body of evidence, lending further support to several interventions which have been advocated as methods to decrease bleeding during endoscopic endonasal surgery. Additional studies have specifically investigated the safety of certain commonly employed techniques. The utility of preoperative corticosteroid therapy and the use of total intravenous anesthetic techniques in increasingly validated. Further evidence supports the safety of reverse Trendelenburg positioning for surgical management of inflammatory disease.

Effect Of Dexmedetomidine On Controlled Hypotension In Hypertensive Patients Undergoing Endoscopic Sinus Surgery

“…Due to the narrow operating space in the nasal cavity, a small amount of bleeding can also hinder the surgeon and mask key anatomical markers, affecting the quality of the surgery. Therefore, how to reduce and control bleeding and improve the clarity of surgical vision has become a key issue in improving the quality of surgery [2]. In clinical practice, epinephrine is commonly used to ll the nasal cavity and contract nasal mucosal blood vessels, and some even inject epinephrine under the nasal mucosa, which has a de nite effect.…”

“…And adrenaline is an adrenaline receptor agonist in the efferent nervous system, which stimulates α and β Receptors can cause hemodynamic uctuations, and shortterm high concentrations of adrenaline entering the bloodstream may even cause cardiovascular and cerebrovascular complications such as hypertension, tachycardia, myocardial ischemia, cardiac arrest, and cerebral hemorrhage. The use of preoperative corticosteroids is also increasingly being reported to reduce intraoperative bleeding during endoscopic sinus surgery [2]. In 1964, Gardner et al[3].…”