phenylephrine-hydrochloride and Blood-Loss--Surgical

Nasal surgeries (such as Functional Endoscopic Sinus Surgery, Rhinoplasty, and Septorhinoplasty) are popular procedures. But perioperative bleeding, eyelid edema, and periorbital ecchymosis remain problems. Tranexamic acid (TXA) is an antifibrinolytic, and it was used to reduce the perioperative bleeding. However, there is no enough evidence judging its safety and efficiency. Therefore, a meta-analysis is conducted by us to evaluate the role of TXA in patients undergoing nasal surgeries.. A search of the literature was performed until June 2018; the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. Only randomized controlled trial (RCT) articles were included, and subgroup analysis was established to deal with heterogeneity. RevMan 5.3 software was selected to conduct the meta-analysis.. Eleven RCTs were included in our meta-analysis. There were significant differences in blood loss (P < .001), surgical field quality (P < .001), edema rating of upper (P < .001) and lower (P < .001) eyelid, ecchymosis rating of upper (P < .001) and lower eyelid (P < .001) when comparing the TXA group to the placebo group. However, the difference in operation time (P = .57) was not significant between the two groups.. Perioperative TXA could reduce the blood loss and improve the quality of surgery field during nasal surgery, and it was helpful for reducing the edema and ecchymosis after nasal surgeries, but it has little influence in reducing the operation time.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Ecchymosis; Edema; Eyelid Diseases; Humans; Nasal Surgical Procedures; Nose; Operative Time; Randomized Controlled Trials as Topic; Tranexamic Acid

Endoscopic transnasal approaches to the skull base and intracranial disease are an emerging subspecialty. The limits of this approach are often dictated by exposure and blood loss. Cell salvage techniques are widely used in other surgical fields. However, in otolaryngology, questions remain regarding its safety because work is performed in a contaminated field. In this literature review, we present the evidence for perioperative cell saver blood transfusion in potentially contaminated fields and the need for further investigation of its use in endonasal surgery.. MEDLINE and Evidence Based Medicine Reviews databases were searched for relevant articles.. All English articles discussing autologous blood transfusion in endonasal surgery were reviewed.. Despite a wide search pattern, no articles that discuss this topic were found in the English literature. Therefore, we went on to present data on the general use of cell saver blood in contaminated fields.. Cell saver blood is widely accepted in surgery. It offers many advantages in elective operations in which blood loss is expected to be significant. Cell saver blood has been transfused from contaminated fields in other forms of surgery without an associated increase in morbidity. There is good evidence that antibiotic prophylaxis is mandatory in this setting. There is no direct evidence that cell salvage blood is safe in endonasal surgery. Cell salvage is part of a multimodality approach, including the use of hypotensive anesthesia, topical procoagulants, a dedicated team with appropriate equipment, and a good surgical technique with a focus on hemostasis.

Topics: Blood Loss, Surgical; Blood Preservation; Blood Transfusion, Autologous; Cytapheresis; Endoscopy; Erythrocyte Transfusion; Humans; Nose

Obtaining adequate hemostasis during otolaryngology operations is necessary because a small amount of blood can be problematic and obscure the visual field. The authors aimed to compare the efficacy of combined greater palatine canal (GPC) and transnasal injection of lidocaine + epinephrine to transnasal injection alone in patients who underwent septoplasty.. Patients with nasal septum deviation who were eligible for surgical correction of deviations were enrolled. Transnasal injections of 2 mL of 1% lidocaine + epinephrine 1:100,000 were performed in both groups and for patients in the combination group the same solution was also injected in the GPC. Objective (amount of suctioned blood) and subjective (intraoperative bleeding score) assessments were done during operation. Close hemodynamic monitoring was performed for all patients.. A total of 50 patients were enrolled and randomly allocated to study groups. No significant differences were observed in systolic and diastolic blood pressure, heart rate, and mean arterial pressure of study subjects between 2 groups. The amount of bleeding in patients who received GPC injection and their counterparts in the other arm of the trial were 34.64 ± 26.66 and 100.48 ± 20.90 mL, respectively (P < 0.001). The mean intraoperative bleeding score in combination group was 0.79 ± 0.42 and significantly lower than the corresponding figure in monotherapy group, which was 1.75 ± 0.41 (P < 0.001).. Based on the findings of the current study, the authors suggest that combined GPC and transnasal injection of lidocaine and epinephrine is a safe and effective method for reducing bleeding during septoplasty.

Topics: Adult; Anesthetics, Local; Blood Loss, Surgical; Double-Blind Method; Drug Therapy, Combination; Epinephrine; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Injections; Lidocaine; Male; Nasal Septum; Nose; Prospective Studies; Rhinoplasty; Treatment Outcome; Vasoconstrictor Agents

This study aimed to compare differences between medicated and nonmedicated Merocel middle meatal spacers (MMSs) on sinonasal mucosal healing (histopathologic and endoscopic difference), patient discomfort, and pain on removal of the MMS following functional endoscopic sinus surgery.. Forty-eight patients with chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive a medication-soaked Merocel MMS (either one of budesonide, gentamicin, or manuka honey) in one nostril and a nonmedicated Merocel MMS in the contralateral side. Patients were seen on postoperative day 7 and were asked to complete a visual analogue score to report the level of discomfort from nasal packing on each side. Under endoscopic visualization, biopsies of mucosa were taken from both middle meati and assessed by a blinded pathologist to determine the level of mucosal inflammation on a scale of 0 to 4.. The budesonide-soaked Merocel MMS showed a trend toward reduced mucosal inflammation when compared to the control Merocel MMS, but the results were not statistically significant. There was no statistically significant difference in the degree of discomfort and pain on the removal of the packings between the medication-soaked Merocel MMS and the nonmedicated Merocel MMS, although there was a trend toward less pain for the manuka honey-soaked Merocel MMS.. Although our study failed to show any significant benefit from the addition of medication to the Merocel MMS, further studies with different compounds are recommended to determine whether a medicated MMS could indeed be a superior alternative to the standard MMS.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Chronic Disease; Double-Blind Method; Endoscopy; Female; Follow-Up Studies; Formaldehyde; Hemostatics; Humans; Male; Middle Aged; Nose; Pain Measurement; Polyvinyl Alcohol; Prospective Studies; Rhinitis; Sinusitis; Surgical Sponges; Treatment Outcome; Wound Healing; Young Adult

In this study, we compared the use of preincisional lidocaine 2% with epinephrine (LA) and levobupivacaine 0.25% plain (LB) for postoperative analgesia and vasoconstriction in patients undergoing nasal surgery.. Sixty patients were randomly assigned to receive preincisional local infiltration under general anesthesia. Group LB received levobupivacaine 0.25%, and group LA received epinephrine plus lidocaine 2% (add volume injected). Intraoperative hemodynamic changes, pre- and postoperative hemoglobin and hematocrit values were recorded. Visual analog scale values 30 min and 1, 2, 8, 12, and 24 h postoperatively and the need for rescue analgesic treatment in the first 24 h of all patients was recorded.. At 30 min and 1, 2, 8, and 12 h postoperatively, visual analog scale values were lower in group LB than in group LA (P < 0.0001, P = 0.002, P = 0.023, P < 0.0001, and P = 0.011, respectively). The analgesic requirement was significantly lower in group LB when compared with that in group LA (P = 0.038). Group LB had significant differences between preoperative and postoperative hemoglobin and hematocrit values (P = 0.014 and 0.025). Group LA had significant differences between preoperative and postoperative hemoglobin and hematocrit values (P = 0.031 and 0.024).. We conclude that postoperative analgesia in nasal surgery with local infiltration of levobupivacaine was significantly more potent and longer lasting than that achieved by lidocaine plus epinephrine.

Topics: Adult; Analgesics; Anesthetics, Local; Blood Loss, Surgical; Bupivacaine; Double-Blind Method; Drug Therapy, Combination; Endoscopy; Epinephrine; Female; Hematocrit; Hemoglobins; Humans; Levobupivacaine; Lidocaine; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Prospective Studies; Rhinoplasty; Time Factors; Vasoconstriction; Vasoconstrictor Agents

A prospective randomized study was undertaken to compare the qualities of calcium sodium alginate (Kaltostat), trousered paraffin gauze, and glove finger packs as nasal packing material following the operation of partial inferior turbinectomy. All three types of packing material were found to be similarly effective in preventing bleeding whilst the packs were in situ. Calcium sodium alginate (Kaltostat) was associated with significantly less bleeding on pack removal than the other two packing materials. Further, irrespective of the material used, leaving the packs in situ for 48 hours produced significantly less bleeding than when they were removed after 24 hours.

Topics: Blood Loss, Surgical; Female; Humans; Male; Nose; Postoperative Care; Prospective Studies; Tampons, Surgical

Alginates are highly absorbent, gel-forming materials with haemostatic properties. The aim of this study was to compare calcium alginate to Telfa as a postoperative nasal pack in a prospective randomised clinical trial. Eighty two patients entered the trial. There were 55 males and 27 females whose ages ranged from 13 to 74 years (mean 34.7 years). Immediate postoperative bleeding was controlled in all cases irrespective of the pack used. There was no difference in the incidence of postoperative complications between the two groups. Calcium alginate is a safe and effective alternative to Telfa as a postoperative nasal pack.

Topics: Adolescent; Adult; Aged; Alginates; Blood Loss, Surgical; Female; Glucuronic Acid; Hemostatics; Hexuronic Acids; Humans; Male; Middle Aged; Nose; Prospective Studies

Topics: Blood Loss, Surgical; Hemostasis, Surgical; Humans; Mohs Surgery; Nose; Nose Neoplasms; Pressure; Skin Neoplasms

A five-level training program was first proposed 10 years ago for surgeons learning endoscopic endonasal surgery (EES) of the skull base. Levels were based on the complexity of anatomy, risk of neurovascular injury, intradural dissection, technical difficulty and vascularity of tumors.. A three-phase validation concept is proposed: 1) face validity (the classification is related to clinically significant elements), 2) construct validity (the classification predicts the outcome), and 3) inter-team validation (the classification applies to other surgical teams). Consecutive cases over a 1-year time span were retrospectively classified. Primary outcome measures included: complication rates (cranial nerve injury, stroke and vascular injury, cerebrospinal fluid [CSF] leak and infection), estimated blood loss and duration of surgery.. Two hundred and nine consecutive cases were analyzed. The distribution of cases for each category was: 63 cases in level II, 70 cases in level III, 66 cases in level IV, and 10 cases in level V. Construct validity demonstrated statistical difference with increasing rate of complications from level II to level III and from level III to level IV; also, specific rates of cranial nerve injury and CSF leak increased between levels III and IV. Face validity identified 162 citations since publication of the original article. Inter-team validation demonstrated no difference between two teams of surgeons.. This study provides a three-phase validation of training levels for endoscopic skull base surgery. Adoption of a progressive systematic approach to learning EES from least complex to advanced procedures is expected to minimize the risks while surgical teams gain experience.. 3 Laryngoscope, 129:2253-2257, 2019.

Topics: Adult; Blood Loss, Surgical; Clinical Competence; Female; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Neurosurgical Procedures; Nose; Operative Time; Postoperative Complications; Retrospective Studies; Skull Base; Surgeons; Teaching

The objective of this study was to describe outcomes for patients who underwent titanium mesh reconstruction of full-thickness nasal defects without internal lining repair. This is a retrospective cohort study. Patients with through-and-through nasal defects were identified at a single academic institution between 2008 and 2016. Nasal reconstruction was performed with either titanium mesh and external skin reconstruction without repair of the intranasal lining or traditional three-layer closure. Five patients underwent titanium mesh reconstruction and 11 underwent traditional three-layer repair. Median follow-up was 11 months (range, 2-66 months). The only significant difference between groups was older age in patients undergoing titanium reconstruction (mean, 81 vs. 63 years; difference of 18; 95% confidence interval [CI], 4-32 years). Defect extent including overall size and structures removed was similar between groups (

Topics: Aged; Aged, 80 and over; Blood Loss, Surgical; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Nasal Mucosa; Nose; Nose Deformities, Acquired; Nose Neoplasms; Operative Time; Postoperative Complications; Radiotherapy; Retrospective Studies; Rhinoplasty; Surgical Flaps; Surgical Mesh; Titanium

To describe the early experience of resecting skull base tumor via a radiofrequency ablation-assisted endoscopic endonasal approach, investigate the safety and feasibility of the technique, and to assess its preliminary treatment outcomes.. Ten patients with skull base tumor who were admitted between September and November 2013 were operated on through a radiofrequency ablation-assisted endoscopic endonasal approach in Xuanwu hospital of capital medical university. In this study, the operative technique was described, and the degree of resection, complications and the early clinical outcomes was presented.. Complete resection was achieved in all patients using this technique. No patient in the series experienced a new neurological deficit, cerebrospinal fluid leak or meningitis after surgery. No recurrence and death related to skull base tumor were found in the follow-up period (16-18 months). The volume of intraoperative blood loss was 60 to 1 000 ml (medium 285 ml). The duration of operations was from 42 to 150 min (medium 95 min). The hospital stay was from 14 to 19 d (average 15.7 d).. Our limited experience indicates that this technique is feasible and safe for the complete resection of some skull base tumors in selected cases.

Topics: Blood Loss, Surgical; Catheter Ablation; Cerebrospinal Fluid Leak; Endoscopy; Humans; Neoplasm Recurrence, Local; Nose; Skull Base; Skull Base Neoplasms; Treatment Outcome

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Blood Loss, Surgical; Budesonide; Child; Endoscopy; Humans; Middle Aged; Nose; Young Adult

Topics: Arteries; Blood Loss, Surgical; Humans; Nasal Surgical Procedures; Nose

Topics: Arteries; Blood Loss, Surgical; Humans; Nasal Surgical Procedures; Nose; Nose Neoplasms; Pressure

The goal of this study was to compare perioperative outcomes for the anterior versus posterior approach to the iliac crest for alveolar bone grafting in patients with cleft lip and palate (CLP).. A retrospective cohort study of patients with CLP who had an anterior or posterior iliac crest bone graft during a 10-year period was performed. Available medical records were reviewed and the outcome variables documented included the operation site for bone graft procurement (anterior or posterior), estimated blood loss, duration of operation, concurrent procedures, and length of hospital stay. The 2 groups were compared by t test, Fisher exact test, and multivariate regression to show differences.. There were 239 patients with CLP who had an iliac crest bone graft to the alveolar cleft; 133 had an anterior and 106 a posterior approach for bone graft procurement. The mean estimated blood loss was significantly less with the posterior approach (85 vs 177 mL; P < .0001). The mean operation duration with the posterior approach was longer (4.6 vs 3.5 hours; P < .0001). Most patients in this group (67%), however, had 2 or more additional procedures during the same anesthetic, whereas only 16% of patients in the anterior group had 2 or more additional procedures. The mean length of stay was significantly shorter for the posterior approach (1.7 vs 2.2 days; P < .0001).. These results suggest that patients having a bone graft from the posterior iliac crest have a smaller estimated blood loss and a shorter length of stay. In addition, this approach permits repair of the alveolar cleft and additional procedures, including augmentation of the median tubercle and correction of nasolabial distortions, which are often present in patients with CLP.

Topics: Alveoloplasty; Blood Loss, Surgical; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Cohort Studies; Female; Humans; Ilium; Length of Stay; Lip; Male; Nose; Retrospective Studies; Time Factors; Tissue and Organ Harvesting; Treatment Outcome

Topics: Blood Loss, Surgical; Endoscopy; Humans; Nose; Skull Base

Skull base surgery is evolving from traditional transfacial and transcranial approaches to the endoscopic endonasal approach, a less intrusive corridor for accessing the ventral skull base. This technique eliminates facial scars, expedites recovery, and obviates brain retraction. The goals of surgical excision, whether palliative or curative, are identical: an approach that is less disruptive to normal tissues. By exploiting the sinonasal corridor, the entire ventral skull base may be accessed to successfully treat benign and malignant lesions. The expanding limits of endoscopic skull base surgery have been accompanied by commensurate innovations in reconstructive techniques that are reliable and have been shown to limit postoperative complications. This article describes the basis for this approach and provides the latest outcome data supporting the current state of the art for endoscopic skull base surgery.

Topics: Blood Loss, Surgical; Craniotomy; Diagnostic Imaging; Dissection; Endoscopes; Endoscopy; Equipment Design; Hemostasis, Surgical; Humans; Minimally Invasive Surgical Procedures; Monitoring, Intraoperative; Nose; Plastic Surgery Procedures; Postoperative Complications; Skull Base; Skull Base Neoplasms; Surgical Flaps

Topics: Blood Loss, Surgical; Equipment Design; Hemostasis, Surgical; Humans; Nose; Otorhinolaryngologic Surgical Procedures; Skin Neoplasms; Treatment Outcome

Recent laser and radiofrequency techniques for the treatment of snoring have provided improvements, but intraoperative and postoperative risks, complications, and long-term results have not been explored in a statistically large enough sample of patients. The goal of this article is to provide practitioners with important data and guidelines to help them in decision-making and prepare them to anticipate problems and recommend a systematic approach to avoid or treat complications.. This investigation was a retrospective review of 5,600 cases, performed over a 10-year period by a single investigator, in a private practice setting. The data on complications were gathered from chart review as well as questionnaires filled out on each patient and by patient reports. The inclusion criteria for this review were: 1) patients with a history of chronic snoring or nasal congestion; 2) patients with an American Society of Anesthesiologists physical status classification (ASA) Classes I or II medical history; 3) patients provide a detailed preoperative snoring questionnaires; 4) patients provide informed consent; 5) patients were followed for a minimum of 2 years following surgery; 6) patients completed a comprehensive postoperative survey; 7) operative report stating the exact nature of any complications; 8) surgeons provided a clinical assessment; 9) sleep apnea reports if available; and 10) patient body mass index of less than 30 kg/m2.. Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) was used for the treatment of snoring and mild obstructive sleep apnea in all cases; 40% of patients also had simultaneous nasal radioablation. No fatalities were recorded and fewer than 3% of patients had long-term complications. The most common intraoperative complication was bleeding, which occurred in 9.5% of patients.. Reducing the amount of tissue resected from the soft palate helped reduce or eliminate the common complications of traditional uvulopalatopharyngoplasty procedures. LA-UPPP and radioablation procedures are effective, safe, and can be carried out in an office setting equipped with anesthesia monitors and services. The complications associated with the procedure were rare and usually manageable.

Topics: Adult; Aged; Blood Loss, Surgical; Catheter Ablation; Chronic Disease; Female; Follow-Up Studies; Hiccup; Humans; Laser Therapy; Male; Middle Aged; Nose; Nose Diseases; Palate, Soft; Pharynx; Postoperative Complications; Retrospective Studies; Rhinitis; Safety; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Uvula

Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. In the case of the expanded process, still more numerous interventions are performed with general anesthesia. The objective of research is to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia caused by nitroglycerin and captopril when performing endoscopic operations of accessory nasal sinuses. Fifty-two patients of physical health state 1-2 according to ASA were examined: for 32 the controlled hypotension (Group H) was applied, 20 patients underwent operations in normotension (Group N). All patients on the eve of the operation were premedicated with diazepam; Group H patients on the day of operation received 6.25 mg of captopril. Anesthesia was carried out with fentanyl and halothane steam in the 50:50% mixture of oxygen and laughing gas. In Group H arterial blood pressure was lowered by nitroglycerin infusion. The average arterial blood pressure was maintained in GroupH within the limits of 50-60 mmHg. Hypotension was coordinated with the rising of the head-bed of the operating table at 5 degrees. Hemorrhage was measured by collecting blood with the pump graded with the precision of 25 ml. The visibility of the operative field was evaluated subjectively every 15 minutes according to the scale of 5 points proposed by Fromm. In both groups the average arterial blood pressure values as well as the values of the frequency of heart contractions differed statistically significantly. In the hypotensive group, hemorrhage during operation was less, on the average, (208 ml) than in Group N (349.2 ml). The visibility of the operative field was by one point, on the average, better than in Group H. No anesthetic complications were observed during investigation. In summary, it is possible to state that the controlled arterial hypotension caused by captopril and nitroglycerin reduced significantly intraoperative hemorrhage and improved the visibility of the operative field in endoscopic rhinosurgery.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Anesthesia; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Loss, Surgical; Captopril; Data Interpretation, Statistical; Diazepam; Endoscopy; Female; Humans; Hypotension, Controlled; Male; Middle Aged; Nasal Polyps; Nitroglycerin; Nose; Paranasal Sinuses; Time Factors; Vasodilator Agents

Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Blood Loss, Surgical; Conjunctiva; Craniotomy; Electrocoagulation; Endoscopes; Endoscopy; Female; Humans; Lacrimal Apparatus; Male; Middle Aged; Nerve Compression Syndromes; Nose; Optic Nerve; Optic Nerve Diseases; Optic Nerve Injuries; Orbit; Retrospective Studies; Skull Fractures; Sphenoid Bone; Sphenoid Sinus; Time Factors; Turbinates; Vision Disorders

Although temporary occlusion of the carotid arteries is commonly done to reduce blood loss during nasal surgery in the dog, data supporting its use are mostly anecdotal and subjective. Twelve dogs were placed under general inhalation anesthesia and mechanically ventilated to maintain normocapnea and an end-tidal halothane concentration equivalent to 1.3 times the minimum alveolar concentration. Tourniquets were placed around both carotid arteries of each dog. Both lingual arteries were cannulated in each dog and their heart rate and blood pressure were measured bilaterally. During unilateral carotid artery occlusion, the blood pressures in the ipsilateral lingual artery were significantly (P < 0.05) lower than the preocclusion control pressures and pressures recorded in the contralateral vessel. Bilateral carotid artery occlusion resulted in a further significant (P < 0.05) fall in all lingual arterial pressures. The recorded heart rates only varied significantly from preocclusion control values when they increased during bilateral carotid occlusion (P < 0.05). The results of this study confirm that carotid artery occlusion has the potential to reduce intraoperative blood loss during oronasal surgery in the dog.

Topics: Animals; Blood Loss, Surgical; Blood Pressure; Carotid Arteries; Dog Diseases; Dogs; Heart Rate; Intraoperative Period; Ligation; Nose; Tongue

Topics: Adult; Blood Loss, Surgical; Cold Temperature; Female; Humans; Nose; Rhinoplasty; Sodium Chloride; Vasoconstriction