phenylephrine-hydrochloride and Blood-Coagulation-Disorders

There are many approaches to obtaining a workable endoscopic surgical field in sinus surgery. With extended sinus and transdural endoscopic surgery, a more rigid approach must be taken. There are 3 main factors that invariably lead to poor surgical outcomes in endoscopic sinus and skull base surgery: bleeding, inadequate access, and unidentified anatomic anomalies. Bleeding is arguably the most common reason for incomplete resection. An understanding of microvascular and macrovascular bleeding allows a more structured approach to improve the surgical field in extended endoscopic surgery. The endoscopic surgeon should always be comfortable in performing the same procedure as an open operation. However, converting or abandoning an endoscopic procedure should rarely occur because much of this decision making should take place preoperatively. Along with poor hemostasis, inadequate access is an important cause of poor outcome. Evaluation of the anatomy involved by pathology but also the anatomy that must be removed to allow adequate exposure is important. This article reviews the current techniques used to ensure optimal surgical conditions and outcomes.

Topics: Blood Coagulation Disorders; Dietary Supplements; Embolization, Therapeutic; Endoscopy; Head-Down Tilt; Hemostasis, Surgical; Hemostatic Techniques; Humans; Intraoperative Period; Magnetic Resonance Imaging; Maxillary Artery; Nose; Paranasal Sinuses; Skull Base; Treatment Outcome

Nosebleed in children can result from dryness and picking of the resultant crust over the anterior part of the nasal septum, trauma to the nose, juvenile angiofibroma, or disorders of hemostatic mechanisms. In most cases it is not difficult to treat; often the primary care physician can assist a patient by giving instructions over the telephone to a parent. In the office or hospital, the usual measures are firm pressure, placement of a piece of cotton dipped in a cocaine-epinephrine solution, taking of a brief history, application of petrolatum, and taping of the nose. If bleeding persists, anterior nasal packing and, rarely, posterior packing should be performed. Maxillary artery ligation is done in cases of severe epistaxis. Special care must be taken with children who have a bleeding disorder or who are recovering from adenoidectomy.

Topics: Adenoidectomy; Blood Coagulation Disorders; Child; Epistaxis; Hemostatic Techniques; Histiocytoma, Benign Fibrous; Humans; Nasal Cavity; Nose; Nose Neoplasms; Postoperative Complications; Referral and Consultation

Topics: Adolescent; Bandages; Blood Coagulation Disorders; Carotid Artery, External; Epistaxis; Female; Hemostasis; Humans; Hypertension; Hypnotics and Sedatives; Ligation; Male; Maxillary Artery; Middle Aged; Nasal Decongestants; Nose; Nose Neoplasms; Pressure; Recurrence; Telangiectasia, Hereditary Hemorrhagic; Wounds and Injuries

Topics: Adult; Anticoagulants; Arteries; Blood Coagulation Disorders; Craniocerebral Trauma; Epistaxis; Hematologic Diseases; Hemostasis; Humans; Hypertension; Liver Diseases; Methods; Nose; Nose Diseases; Tampons, Surgical

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelet Disorders; Blood Transfusion; Capillaries; Epistaxis; Hemophilia A; Hemophilia B; Hemorrhage; Hemostasis; Hemostatics; Humans; Nose; Otolaryngology; Pharynx; Surgical Procedures, Operative; Tonsillectomy

The instances in which nosebleed is potentially fatal are those in which there is a history of recent head injury, severe arteriosclerotic cardiovascular disease or an underlying vascular tumor in the nasal chambers. Fatal nasal bleeding has not been reported in children. An awareness on the part of the physician of the potentially fatal significance of his patient's nosebleed is the very best insurance against such an event. Intelligent history-taking, careful physical and x-ray examination, generous sedation, precise local cauterization and packing, estimation of hemoglobin mass and a search for bleeding and clotting disorders are the best weapons of the physician called to treat epistaxis. These procedures, coupled with adequate blood replacement and an informed attitude toward surgical interruption of the blood supply to the bleeding region should forestall death from fatal nosebleed.

Topics: Blood Coagulation Disorders; Cautery; Child; Epistaxis; Humans; Nose