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Habibi AF, Ashraf A, Ghanavi Z, Shakiba M, Nemati S, Aghsaghloo V. Positive End-Expiratory Pressure in Rhinoplasty Surgery; Risks and Benefits. Indian J Otolaryngol Head Neck Surg 2023; 75:2823-2828. [PMID: 37974774 PMCID: PMC10645805 DOI: 10.1007/s12070-023-03854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/02/2023] [Indexed: 11/19/2023] Open
Abstract
Aims The aim of this study is to evaluate the effect of Positive End Expiratory Pressure (PEEP) on surgical field bleeding and its respiratory and hemodynamic consequences in rhinoplasty surgeries. Materials and methods This single-blind clinical trial performed in Amir Al-Momenin university Hospital in 2018. Seventy cases of rhinoplasty surgery patients Enrolled and were randomized into two groups; intervention (PEEP = 5) and comparison group (PEEP = 0). Surgical field bleeding and arterial oxygen saturation pulmonary dynamics and hemodynamic parameters were evaluated during operation and in post anesthesia care unit. Data were analyzed by SPSS software using descriptive and analytical statistics. Results PEEP applying had no negative effect on surgical bleeding as well as surgeon satisfaction, heart rate and blood pressure were similar in two groups. Pulmonary dynamics and oxygenation were stable and within normal values in all cases. The mean peak airway pressure was 17.87 ± 2.24 in the PEEP group and 16.08 ± 3.37 in the ZEEP group (P = 0.029). Conclusion applying low level PEEP during anesthesia improved recovery oxygen saturation but had no negative effects on the patient`s hemodynamics, and did not aggravate bleeding and visual clarity. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03854-7.
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Affiliation(s)
- Ali Faghih Habibi
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Ashraf
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Ghanavi
- Department of Neurosurgery, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shakiba
- Department of Biostatics & Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Vahid Aghsaghloo
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Aremu SK. Knowledge and awareness of aetiological and risk factors as determinants of health-seeking pattern of parents of children with epistaxis in a tertiary health institution: A 7-year prospective study. Afr J Paediatr Surg 2023; 20:211-217. [PMID: 37470558 PMCID: PMC10450115 DOI: 10.4103/ajps.ajps_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 01/22/2023] Open
Abstract
Aim This prospective study aimed to assess the knowledge and awareness of aetiological and risk factors as determinants of the health-seeking pattern of parents of children with epistaxis in a tertiary health institution. Materials and Methods This was a 7-year cross-sectional prospective study where copies of the questionnaire were distributed to consenting parents whose children presented to our institution with epistaxis between January 2015 and December 2021. A total of 570 parents were enrolled in the study in the research time period. Results Out of 570 patients, majority (39%) were aged between 11 and 15 years, followed by 35% aged between 6 and 10 years, 17% aged between 1 and 5 years and 11% aged between 16 and 18 years. Three hundred and eighty (66.67%) were male and 190 (33.33%) were female. Two hundred and ninety-five (51.75%) patients had primary education, followed by 189 (33.16%) patients with secondary education and 86 (15.09%) patients with preschool education. Three hundred and seventy-three (65.44%) patients had anterior bleeding and 107 (18.77%) patients had posterior bleeding while 90 (15.79%) patients had both anterior and posterior bleeding. The majority of the parents, 399 (70%), were aware about the epistaxis while 171 (30%) parents were unaware about the epistaxis. Conclusion A significant number of parents are unaware of the epistaxis and also unaware of the various aetiological and risk factors of the epistaxis and these issues need a more nuanced analysis in light of Africa's rich cultural diversity.
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Affiliation(s)
- Shuaib Kayode Aremu
- Department of ENT, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti, Nigeria
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Maina G, Ooi E. A retrospective review of spontaneous epistaxis outcomes for patients on novel oral anticoagulants compared to antiplatelets and warfarin. Am J Otolaryngol 2022; 43:103488. [PMID: 35537230 DOI: 10.1016/j.amjoto.2022.103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 11/01/2022]
Abstract
AIMS The incidence of epistaxis-related admissions amongst elderly patients is rising due to the increasing use of anticoagulants and antiplatelet agents. This retrospective study evaluates the differences in outcomes for patients on warfarin, novel anticoagulants (NOACs) and antiplatelets over two different time periods. METHODOLOGY Retrospective case-control study with data from patients admitted with epistaxis through the Flinders Medical Centre Emergency Department in the first six months of 2013 and compared to the same period in 2018. The latter coincides with integration of NOACs into Australian prescribing practices. Included participants were ≥50 years with spontaneous epistaxis which coincides with peak incidence in adults. Exclusion criteria were epistaxis due to trauma, intrinsic coagulopathy, or recent post-surgery. Linear regression and binary logistic regression models were the statistical methods used. RESULTS Data from 85 patients were analysed for length of stay (LOS), readmission rates and method of haemostasis. In 2013, 41 patients were included compared to 44 in 2018, suggesting a 7% increase in admissions rates but this was not statistically significant (p = 0.96). The proportion of patients admitted with epistaxis while taking an anticoagulant or antiplatelet agent increased from 66% in 2013 to 93% in 2018. Thirty six percent of patients in 2018 were taking NOACs, however, LOS was 2 times shorter (mean ratio = 2.08 days, 95% CI: 1.03, 4.19). Seven percent of patients in 2018 had bleeding requiring surgery or interventional radiology, compared to 12% in 2013, but this was not statistically significant. There was no statistically significant difference in readmission rates (p = 0.82) or intervention required (p = 0.74) between the two time periods. CONCLUSIONS Epistaxis admissions at our institution have increased since the introduction of NOACs. However, most patients can be managed successfully with intranasal packing and cautery alone. NOACs are not associated with increased rated of invasive haemostatic measures and patients have a shorter LOS.
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Syndromes that predispose to epistaxis. Eur Arch Otorhinolaryngol 2019; 276:939-944. [DOI: 10.1007/s00405-019-05310-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/19/2019] [Indexed: 01/10/2023]
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Reis LR, Correia F, Castelhano L, Escada P. Epidemiology of epistaxis in the emergency department of a southern European tertiary care hospital. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Glikson E, Chavkin U, Madgar O, Sagiv D, Nakache G, Yakirevitch A, Wolf M, Alon EE. Epistaxis in the setting of antithrombotic therapy: A comparison between factor Xa inhibitors, warfarin, and antiplatelet agents. Laryngoscope 2018; 129:119-123. [DOI: 10.1002/lary.27400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Eran Glikson
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | | | - Ory Madgar
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | - Doron Sagiv
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | - Gabriel Nakache
- Department of Otolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Wolf
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eran E. Alon
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Reis LR, Correia F, Castelhano L, Escada P. Epidemiology of epistaxis in the emergency department of a southern European tertiary care hospital. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:331-338. [PMID: 29739664 DOI: 10.1016/j.otorri.2017.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Epistaxis is the most common rhinological emergency seen in the emergency department. The purpose of this study was to evaluate epidemiological data of epistaxis in a southern European tertiary care hospital. METHODS A retrospective study was conducted during the period between January 2009 and December 2015. We analyzed the distribution by cross-referencing the demographic variables, destination after medical discharge, inpatient characteristics (major comorbid diseases, medication, bleeding localization and treatment) and health-care costs with the disease. RESULTS Epistaxis accounted for approximately 1 in 30 visits to the ED and 77 out of a population of 100,000 was served by that ED. Overall, 71,624 patients were treated and 2371 patients presented with epistaxis (3.31%). One-thousand three-hundred and twenty-seven cases were male and 1044 female (p <.001). The mean age was 56 years (±26). Age distribution was bimodal, with peaks among those <10 years and >70 (p <.001). Epistaxis was more common in the winter months (p < 0.001). The main referral destinations (6.8%) included outpatient (2.9%) and inpatient (1.9%) services. Hospitalization was more frequent between the ages of 60 and 80 years (p =.029), and the major comorbidity was hypertension (47.8%). Medication interfering with haemostasis was documented in 30.4%. Most inpatient epistaxis was managed in a non-interventional manner and only. 5% of patients needed surgery. The mean total health-care cost was 69.8 € per episode. CONCLUSION Emergency epistaxis was more frequent in men, the elderly, patients with underlying comorbidities, during the winter months, and showed a higher risk of referral and hospitalization with increasing age (as a result of an aging population in western countries). The main hospital expenses for epistaxis are related to hospitalization and health care costs.
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Affiliation(s)
- Luis Roque Reis
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - Filipe Correia
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Luis Castelhano
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Pedro Escada
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal
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The Rate of Epistaxis Incidence in New-Generation Anticoagulants and Perioperative Approach in Otorhinolaryngological Practices. J Craniofac Surg 2018; 28:e178-e182. [PMID: 27755410 DOI: 10.1097/scs.0000000000003135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Nose bleeding is a common situation seen in otorhinolaryngological practices. One of the greatest risk factors in nose bleeding is the use of anticoagulant medicine. With the medicine developed in recent years, the risk of nose bleeding due to the frequent use of anticoagulant and antiagregant is gradually increasing.The purpose of this study is to determine the effects of especially new-generation anticoagulants on nose bleeding. In addition, the use and complications of new-generation anticoagulants and antiagregants have been compiled in light of information obtained from the literature.Three hundred forty patients whose follow-up is conducted by the cardiology department and who use oral antithrombocytic medicine have been included in the study. It has been determined that 15% of these patients use new-generation oral anticoagulants (Rivaroksaban, apiksaban, dabigatran, danaparoid) and the other patients are treated with conventional antithrombocytic treatment (Aspirin, Warfarin, Enoksaparin sodium). The rate of nose bleeding in patients who use classical anticoagulants has been observed to be 28%. In 30 of these patients who had nose bleeding, while cauterization and buffering by otorhinolaryngology specialists, major intervention has not been necessary for any of the patients. While bleeding has been observed in 26% of the patients who use new-generation anticoagulants, bleeding that required operational intervention has taken place in 2 patients. Bleedings have been stopped surgically through a large number of cauterization and buffering.While the new-generation anticoagulants cause lower rate of bleeding, it has been observed that controlling these bleedings is more difficult.
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Hassen GW, Clemons P, Kaplun M, Kalantari H. Is topical tranexamic acid a better alternative for selected cases of anterior epistaxis management in the ED? Am J Emerg Med 2018; 36:734.e1-734.e2. [PMID: 29310981 DOI: 10.1016/j.ajem.2018.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/03/2018] [Indexed: 11/18/2022] Open
Abstract
Epistaxis is a well-known problem that is mostly self-limited. In certain cases it requires packing or cauterization. Tranexamic acid has been tried and has shown promising results. Here we report a case of prolonged epistaxis in a patient on dual anti-platelet agent therapy.
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Affiliation(s)
- Getaw Worku Hassen
- NYU Langone Hospital-Brooklyn, Department of Emergency Medicine, Brooklyn, NY, United States; NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States.
| | - Paula Clemons
- NYU Langone Hospital-Brooklyn, Department of Emergency Medicine, Brooklyn, NY, United States
| | - Michelle Kaplun
- NYU Langone Hospital-Brooklyn, Department of Clinical Pharmacy, Brooklyn, NY, United States
| | - Hossein Kalantari
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States
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Beck* R, Sorge* M, Schneider A, Dietz A. Current Approaches to Epistaxis Treatment in Primary and Secondary Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:12-22. [PMID: 29345234 PMCID: PMC5778404 DOI: 10.3238/arztebl.2018.0012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/15/2017] [Accepted: 10/17/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lifetime prevalence of epistaxis is approximately 60%, and 6-10% of the affected persons need medical care. In rare cases, severe bleeding calls for the rapid initiation of effective treatment. METHODS This review is based on pertinent articles that were retrieved by a selective search PubMed, and on the authors' clinical experience. RESULTS There are no German guidelines for the management of epistaxis. The available evidence consists mainly of retro spective analyses and expert opinions. 65-75% of the patients who require treatment can be adequately cared for by their primary care physician or by an emergency physician with baseline measures. If there is persistent anterior epistaxis, an otorhinolaryngologist can control the bleeding sastisfactorily in 78-88% of cases with chemical or electrical cauterization. Nasal packing is used if this treatment fails, or for posterior epistaxis. In a retrospective study, surgical treatment was found to be more effective than nasal packing in the treatment of posterior epistaxis (97% versus 62% treatment success). Percutaneous embolization is an alternative treatment for patients whom general anesthesia would put at high risk. CONCLUSION The treatment of severe or recurrent epistaxis requires the interdisciplinary collaboration of the primary care physician, the emergency physician, the practice-based otolaryngologist, and the hospital otolaryngology service. Uniform guidelines and epidemiological studies on this topic would be desirable.
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Affiliation(s)
- Rafael Beck*
- * Both authors contributed equally to this paper
- Department of Otolaryngology, University of Leipzig
| | - Martin Sorge*
- * Both authors contributed equally to this paper
- Department of Otolaryngology, University of Leipzig
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Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery. Case Rep Otolaryngol 2016; 2016:8504348. [PMID: 28025632 PMCID: PMC5153481 DOI: 10.1155/2016/8504348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/16/2016] [Indexed: 12/03/2022] Open
Abstract
A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator's experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.
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The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial. Aesthetic Plast Surg 2016; 40:453-7. [PMID: 27225876 DOI: 10.1007/s00266-016-0653-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/05/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a rich blood flow to the mucosa in the nasal region. In rhinoplasty, surgical procedures are performed in a narrow and confined space. So bleeding during surgery reduces visibility which can complicate the procedure. This study investigated the effects of the patient position on amount of intraoperative bleeding during surgical procedures. PATIENTS AND METHODS This randomized controlled trial was conducted on 71 patients who underwent elective rhinoplasty. The patients were operated on in three groups. Group 1 consisted of 23 patients who were operated on in the supine position; Group 2 included 28 patients who were operated on using a 15° angle reverse Trendelenburg position; Group 3 consisted of 20 patients who were operated on at a 20° angle reverse Trendelenburg position. RESULTS There were statistically significant differences between the groups in regard to surgeon satisfaction and the amount of intraoperative bleeding. The amount of intraoperative bleeding in Group 1 was significantly higher than those of Groups 2 and 3, and surgeon satisfaction was lower. CONCLUSIONS Reverse Trendelenburg position reduces intraoperative bleeding in rhinoplasty patients while facilitating the procedure compared to the supine position. Surgery at a 15° angle reverse Trendelenburg position provides the optimum working conditions by both significantly reducing intraoperative bleeding and allowing for comfortable conditions for the surgeon. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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