Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery

Abstract

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