The effect of deep and awake extubation on emergence agitation after nasal surgery: a randomized controlled trial

BACKGROUND

Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake.

METHODS

A total of 202 patients (18-60 years, American Society of Anesthesiologists classification: I-II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events.

RESULTS

The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p < 0.001). Compared to group A, patients in group D had lower Richmond Agitation-Sedation Scale scores, higher Ramsay sedation scores, fewer agitation episodes, and lower mean arterial pressure when extubated and 30 min after surgery, whereas these indicators did not differ 90 min after surgery. There was no difference in the incidence of adverse events between the two groups.

CONCLUSIONS

Extubation under deep anesthesia can significantly reduce emergence agitation after nasal surgery under general anesthesia without increasing the incidence of adverse events.

TRIAL REGISTRATION

Registered in Clinicaltrials.gov (NCT04844333) on 14/04/2021.

A 3-year follow-up study after nasal reconstruction surgery in patients with empty nose syndrome

KEY POINTS

Empty nose syndrome (ENS) is characterized by a patent nasal airway and a sense of nasal obstruction. ENS and psychological symptoms improved after surgery and remained stable for up to three years. Identifying residual disease is necessary for enhancing therapeutic outcomes in ENS patients.

Tranexamic acid in bleeding reduction and operative time of nasal surgeries: systematic review and meta-analysis

PURPOSE

Our study goal is to review the efficacy of tranexamic acid in reducing blood loss and operative time in nasal surgeries.

METHODS

We included randomized clinical trials using oral or intravenous tranexamic acid, excluded non-randomized studies, topic administration, coagulopathy, and using other drugs interfering in the coagulation cascade. Online databases, National Library of Medicine (MEDLINE-PubMED), Latin American and Caribbean Literature on Health Sciences (Lilacs), Cochrane Library, Embase and Google Scholar were used to perform the search. The review was registered in PROSPERO by no CRD42022310977. Two authors, independently, selected the articles meeting the inclusion criteria. They extracted the data and used RevMan 5 software to perform the meta-analysis.

RESULTS

Our search resulted in 16 RCTs that were included in the meta-analysis totalizing 1108 patients. Studies were evaluated resulting in a low risk of bias for the five domains. The use of tranexamic acid resulted in significant reduction in duration of surgery (DOS) and intraoperative blood loss (IBL) had significant reduction. The level of evidence according to GRADE System was high in all studies and variables.

CONCLUSION

Tranexamic acid has an important role in reducing intraoperative blood loss and duration of surgery. Our study has some limitations due to the low number of RCTs available in the literature.

Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

OBJECTIVES

Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years.

METHODS

A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention.

RESULTS

Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR (P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR.

CONCLUSIONS

General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR.

A case report: A patient rescued by VA-ECMO after cardiac arrest triggered by trigeminocardiac reflex after nasal surgery

RATIONALE

Cardiac arrest (CA) caused by trigeminocardiac reflex (TCR) after endoscopic nasal surgery is rare. Hence, when a patient suffers from TCR induced CA in the recovery room, most doctors may not be able to find the cause in a short time, and standard cardiopulmonary resuscitation and resuscitation measures may not be effective. Providing circulatory assistance through venous-arterial extracorporeal membrane oxygenation (VA-ECMO) can help healthcare providers gain time to identify the etiology and initiate symptom-specific treatment.

PATIENT CONCERNS

We report a rare case of CA after endoscopic nasal surgery treated with VA-ECMO.

DIAGNOSES

We excluded myocardial infarction, pulmonary embolism, allergies, hypoxia, and electrolyte abnormalities based on the relevant examination results. Following a multidisciplinary consultation, clinical manifestation and a review of previous literature, we reasoned that the CA was due to TCR.

INTERVENTIONS

VA-ECMO was established to resuscitate the patient successfully during effective cardiopulmonary resuscitation.

OUTCOMES

ECMO was successfully evacuated a period of 190 minutes of therapy. The patient was discharged home on day 8.

LESSONS

TCR is notable during endoscopic nasal surgery. Our case indicates that CA in operating room is worth prolonged CCPR. The ideal time for ECPR implementation should not be limited within 20 minutes after CCPR.

Platelet-rich plasma injection for empty nose syndrome: A case report

Empty nose syndrome (ENS) is a relatively rare disease found in patients who have undergone sinonasal surgery, characterized by excessive reduction of the turbinate, causing intranasal turbulence and loss of receptors within the nasal mucosa. Patients diagnosed with the disease usually experience symptoms including dryness of the nose, nasal pain, paradoxical nasal obstruction, and crusts in the nasal cavity. ENS can be treated with conservative care such as nasal irrigation or nasal moisturizers. Accurate efficacy of surgical treatment of ENS is often difficult to predict and is accompanied by operational obstacles and complications. Platelet-rich plasma (PRP) has recently gained attention as a regenerative therapy in several medical fields. We present two cases of ENS treated by injection of PRP as a simple and less invasive method, and describe its efficacy with nasal endoscopy and subjective questionnaires.

Opiate vs non-opiate prescription medication for pain control after endoscopic sinus surgery for chronic rhinosinusitis

PURPOSE

Research indicates that most providers give opiates after endoscopic sinonasal surgery. The effectiveness of non-opiate medications after sinonasal surgery is poorly understood and most studies do not assess medication failure. This study compares oral opiate, oral opiate and topical steroid, and oral non-opiate pain control. Patient call-backs are used as a proxy for pain medication failure.

MATERIALS AND METHODS

This study compares three medication regiments after sinonasal surgery for 180 adults with chronic rhinosinusitis. Patients were instructed to take acetaminophen for mild pain. For moderate/severe pain, patients used: 1) oxycodone-acetaminophen, 2) oxycodone-acetaminophen + budesonide nasal rinses, or 3) meloxicam + acetaminophen. Patients were instructed to call clinic if pain was not controlled. Descriptive statistics compared cohorts. Chi-square tests compared call-backs between cohorts. Logistic regression adjusted for baseline differences in covariates, comorbidities, and operative sites.

RESULTS

Cohorts had similar age, sex distribution, disease features, and extent of surgery. The meloxicam cohort had less subjects with pain disorders. The oxycodone cohort had less subjects with diabetes, septoplasty, and turbinate reduction. After adjusting for baseline differences and using oxycodone as the reference group (n = 50), the odds of calling clinic for poorly controlled pain was 0.18 (95% Confidence Interval (CI): 0.05-0.6) in the meloxicam cohort (n = 45) and 0.19 (95% CI:0.07-0.5) in the oxycodone + budesonide rinses cohort (n = 85).

CONCLUSION

In this study, both meloxicam and oxycodone + budesonide rinses were more effective at controlling pain after sinonasal surgery than oxycodone alone.

Dexmedetomidine-soaked nasal packing can reduce pain and improve sleep quality after nasal endoscopic surgery: a double-blind, randomized, controlled clinical trial

STUDY OBJECTIVE

Bilateral endoscopic nasal surgery is usually associated with pain and sleep disturbance. The aim of this study was to evaluate the effects of dexmedetomidine-soaked nasal packing on analgesia and improvement of sleep quality in patients undergoing this surgery.

METHOD

Eighty patients were enrolled and randomly allocated into 4 groups. At the end of surgery, dexmedetomidine-soaked nasal packings were applied to three groups with a dosage of 1 μg kg^-1 (D1), 2μg kg^-1 (D2), 4 μg kg^-1 (D4) and normal saline-soaked nasal packing (NS) was applied to a fourth group. The primary outcome was postoperative pain scores using a visual analog scale (VAS) recorded at six time points: before the surgery (T1); 2 h (T2), 8 h (T3), 24 h (T4), 48 h (T5) after surgery; and at the moment of nasal packing removal (T6). Secondary outcomes were postoperative sleep status evaluated by the Pittsburgh sleep quality index (PSQI) and subjective sleep quality value (SSQV). Factors affecting sleep, hemodynamic changes, and adverse events were also recorded.

RESULTS

Compared with the NS group, dexmedetomidine-soaked nasal packing significantly relieved postoperative pain and improved sleep quality. The effect was similar between D2 and D4, which was greater than in D1. However, D2 was associated with fewer adverse events.

CONCLUSIONS

Dexmedetomidine-soaked nasal packing not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing bilateral endoscopic nasal surgery. Taking effect and adverse events into consideration, a dosage of 2μg kg^-1 may be optimal.

TRIAL REGISTRATION

www.chictr.org.cn/index.aspx (ChiCTR1900025692) Retrospectively registered 5 September 2019.

Unilateral mydriasis following septoplasty with inferior turbinate reduction

Nasal septoplasty and inferior turbinate reduction are common procedures performed in the treatment of nasal obstruction. These procedures are generally considered to be safe with minimal reported complications. Herein, we describe a case of a 43-year-old female who developed transient unilateral mydriasis following septoplasty with inferior turbinate reduction, likely due to the sympathomimetic agents used for vasoconstriction and mucosal decongestion.

Electroacupuncture for postoperative pain after nasal endoscopic surgery: study protocol for a pilot randomized controlled trial

BACKGROUND

Postoperative pain is common after nasal endoscopic surgery. It interferes with the quality of sleep and delays postoperative recovery. Acupuncture is an effective tool for pain management. However, electroacupuncture specifically for the relief of postoperative pain after nasal endoscopic surgery has not yet been studied in a randomized controlled trial.

METHODS/DESIGN

This randomized sham-controlled patient- and assessor-blind pilot trial has been designed to evaluate the efficacy and safety of electroacupuncture in managing postoperative pain following nasal endoscopic surgery to treat sinusitis due to nasal polyps. Altogether, 30 participants will be randomly allocated to an electroacupuncture or non-invasive sham control in a 1:1 ratio. Treatment will occur within 2 h before the operation, immediately after the operation upon arrival in the recovery ward, and once daily for 3 days. The primary outcome is the pain numerical rating scale, which will be analyzed using the area under the curve. The secondary outcome measures include heart rate and blood pressure after the operation, sleep quality during the hospital stay (actigraph), quality of recovery, and the 36-item short form health survey. This trial will use an intention-to-treat analysis.

DISCUSSION

This pilot randomized controlled trial will explore the feasibility of the further clinical application of electroacupuncture for the management of postoperative pain. It will inform the design of a further full-scale trial.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900024183. Registered on 29 June 2019.

Patient-recorded benefit from nasal closure in a Danish cohort of patients with hereditary haemorrhagic telangiectasia

BACKGROUND

Nasal closure, also known as the modified Young's procedure was introduced in Denmark in 2008, as a surgical solution to severe epistaxis in patients with hereditary haemorrhagic telangiectasia (HHT). The objective of this study was to report the overall satisfaction of the procedure from a patient's point of view as well as the occurrence of complications.

METHODS

All the HHT patients who underwent nasal closure from 2008 to 2018 were included in the study. The patients were evaluated for postoperative complications and subjective outcome using Glasgow Benefit Inventory (GBI).

RESULTS

Ten patients were included in the study and were observed for a mean of 64 months. None of the patients was completely free of complications, and reversal was requested in a single case. Haemoglobin levels rose with an average of 2.8 g/dl. The average GBI score after surgery was 38.05. Nine of ten patients would recommend nasal closure to fellow HHT patients.

CONCLUSION

Nasal closure is highly recommended among patients, but due to the rate of postoperative complications, the procedure should be reserved for a carefully selected group of HHT patients.

Expert panel process to optimise the design of a randomised controlled trial in chronic rhinosinusitis (the MACRO programme)

BACKGROUND

MACRO (Defining best Management for Adults with Chronic RhinOsinusitis) is an NIHR-funded programme of work designed to establish best practice for adults with chronic rhinosinusitis (CRS). The 7-year programme comprises three consecutive workstreams, designed to explore NHS care pathways through analysis of primary and secondary data sources, and to undertake a randomised controlled trial to evaluate a longer-term course of macrolide antibiotics and endoscopic sinus surgery for patients with CRS. A number of outstanding elements still required clarification at the funding stage. This paper reports an expert panel review process designed to agree and finalise the MACRO trial design, ensuring relevance to patients and clinicians whilst maximising trial recruitment and retention.

METHODS

An expert panel, consisting of the MACRO Programme Management Group, independent advisors, and patient contributors, was convened to review current evidence and the mixed-method data collected as part of the programme, and reach agreement on MACRO trial design. Specifically, agreement was sought for selection of macrolide antibiotic, use of orally administered steroids, inclusion of CRS phenotypes (with/without nasal polyps), and overall trial design.

RESULTS

A 12-week course of clarithromycin was agreed as the main trial comparator due to its increasing use as a first- and second-line treatment for patients with CRS, and the perceived need to establish its role in CRS management. Orally administered steroids will be used as a rescue medication during the trial, rather than routinely either pre or post trial randomisation, to limit any potential effects on surgical outcomes and better reflect current UK prescribing habits. Both CRS phenotypes will be included in a single trial to ensure that the MACRO trial is both pragmatic and generalisable to primary care. A modified, three-arm trial design was agreed after intense discussions and further exploratory work. Inclusion criteria were amended to ensure that the patients recruited would be considered eligible for the treatment offered in the trial due to having already received appropriate medical therapy as deemed suitable by their ENT surgeon. A proposed 6-week run-in period prior to randomisation was removed due to the new criteria prior to randomisation.

CONCLUSION

The expert panel review process resulted in agreement on key elements and an optimal design for the MACRO trial, considered most likely to be successful in terms of both recruitment potential and ability to establish best management of patients with CRS.

Postoperative epistaxis and sphenoid sinus ostial stenosis after posterior septal branch injury during sphenoidotomy

BACKGROUND

Postoperative arterial epistaxis and sphenoid sinus stenosis after sphenoidotomies for endoscopic sinus surgery (ESS) and transsphenoidal approaches (TSAs) are uncommon. One potential source of epistaxis after sphenoidotomy is the sphenopalatine artery's posterior septal branch (PSB). PSB injury, in addition to other factors, could increase the risk of sphenoid stenosis. The purpose of this study was to determine incidence of, and risks factors for, the following outcomes after sphenoidotomy: PSB injury; postoperative epistaxis from the injured PSB; and sphenoid stenosis after PSB injury.

METHODS

A single-institution, prospective case series was conducted based on 233 sphenoidotomies performed during ESS (n = 163) and TSAs (n = 70). Outcome measures included intraoperative PSB injury, postoperative epistaxis from the PSB, and sphenoid stenosis.

RESULTS

The incidence of PSB injury was 17.2% during ESS-related sphenoidotomies, and 5.7% during TSA-related sphenoidotomies (p = 0.010). After PSB injury during ESS- and TSA-related sphenoidotomies (n = 32), there was 1 instance of epistaxis from the PSB (3.1%). Of the 161 ESS-related sphenoidotomies, 6 developed complete or near-complete stenosis (3.7%), which was more likely to occur with smaller anterior sphenoid face dimensions (p = 0.001). PSB injury, revision sphenoidotomy, and other factors did not increase the risk of stenosis. None of the TSA-related sphenoidotomies stenosed completely. Median follow-up was 7 months.

CONCLUSION

PSB injury occurred in 17.2% of ESS-related sphenoidotomies and 5.8% of TSA-related sphenoidotomies. After PSB injury, postoperative epistaxis from the PSB was rare (3.1%). After ESS-related sphenoidotomies, sphenoid stenosis was rare (3.7%), and was more likely to occur with smaller sphenoid dimensions, but not with PSB injury or other factors.

Role of tranexamic acid in nasal surgery: A systemic review and meta-analysis of randomized control trial

OBJECTIVE

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.

METHOD

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.

RESULT

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.

CONCLUSION

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.

[The clinical observation of NK/T-cell lymphoma of the nasal type]

The objective of the present work was to present the results of the clinical analysis of the patient presenting with natural killer (NK)/T-cell lymphoma of the nasal type. We undertook the analysis of the medical documentation concerning the case of interest. It was shown that the development of progressive perforation of the nasal septum and the pronounced destructive changes in the intranasal and adjacent structures following the endonasal surgical interventions made necessary differential diagnostics between the condition under consideration and certain latent disorders (such as Wegener's granulomatosis, leprosy, syphilis, leishmaniasis, dirofilariasis tuberculosis, etc.). The study has demonstrated that the negative results of the analysis imply the necessity of special attention to the possibility of development of oncological diseases including hematological disorders (e.g. NK/T-cell lymphoma) and the repeat careful follow-up examination of the patients by the experienced experts.

Ventricular pneumocephalus, cervical subarachnoid pneumorrhachis, and meningoencephalitis in a dog following rhinotomy for chronic fungal rhinitis

CASE DESCRIPTION

A 5-year-old 35.8-kg (78.8-lb) neutered male Labrador Retriever was evaluated for chronic nasal discharge associated with a fungal infection. The dog had previously been prescribed antimicrobials and antifungal treatment, but owner compliance was lacking.

CLINICAL FINDINGS

Bilateral mucopurulent nasal discharge, mild ulceration of the left nasal commissure, and hyperkeratosis of the dorsal nasal planum were present. Computed tomography revealed destruction of the intranasal structures, focal lysis of the cribriform plate, and invasion of a soft-tissue mass into the frontal cortex. Rhinoscopy revealed a large pale mass in the caudal aspect of the right nasal passage; a biopsy sample was consistent with Aspergillus sp on histologic evaluation.

TREATMENT AND OUTCOME

Initial treatment included medical management with an antifungal agent. Approximately 3 months later, a large fungal granuloma in the right frontal sinus was removed and debridement was performed via dorsal rhinotomy. One month after surgery, the dog was evaluated for signs of cervical pain and altered mentation. An MRI and CSF analysis were performed; diagnoses of ventricular pneumocephalus, subarachnoid pneumorrhachis, and meningoencephalitis were made. Management included oxygen therapy and administration of antimicrobials, analgesics, and antifungal medications. On follow-up 9 months after initial evaluation, neurologic deficits were reportedly resolved, and the dog was doing well.

CONCLUSIONS AND CLINICAL RELEVANCE

This report emphasizes the importance of prompt, appropriate treatment of fungal rhinitis in dogs. Although rare, pneumocephalus and pneumorrhachis should be included as differential diagnoses for neurologic signs following treatment for this condition. In this dog, the complications were not considered severe and improved over time with supportive care.

A preliminary report on the role of endoscopic endonasal nasopharyngectomy in recurrent rT3 and rT4 nasopharyngeal carcinoma

Endoscopic endonasal nasopharyngectomy (EEN) has become increasingly used for recurrent nasopharyngeal carcinoma (rNPC) due to reduced functional and cosmetic morbidities compared to conventional external approach. Majority of the existing studies on EEN focused on patients with lower recurrent staging of rT1 and rT2. The aims of this study were to provide a preliminary report on the outcome of EEN performed in patients with advanced (rT3 and rT4) rNPC, and to determine the prognostic factors for patients' survival. All patients who underwent EEN for rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah, by a single surgeon. We reported the 2-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Fifteen patients with recurrent NPC (2 rT3 and 13 rT4 tumours) underwent EEN over the 13 years period. The mean age was 50.4 years (range 30-65) and the mean follow-up period was 28.7 months (range 9-81 weeks). The 2-year OS, DFS and DSS were 66.7 % (mean 19.4 months), 40 % (mean 15.7 months) and 73.3 % (mean 20.2 months), respectively. No severe operative complications were encountered. No independent prognostic factors for survival outcome were identified. This is the first preliminary report in English that exclusively looked at the use of EEN in advanced rT3 and rT4 NPCs, showing favourable patient outcome. However, further long-term follow-up of patients is required.

Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report

In this paper, we present the results of coblation nasal septal swell body (NSB) reduction for the treatment of nasal obstruction in patients with abnormally thickened NSB. The study design was a retrospective clinical series conducted at a single tertiary medical center. Eight patients underwent coblation NSB reduction. Pre-operative and post-operative nasal functions were evaluated by acoustic rhinometry and subjective symptom scales. We also analyzed pre-operative CT scan images and nasal endoscopic findings. The mean maximal NSB width was 16.4 ± 2.2 mm on pre-operative coronal CT scan images. The mean visual analog scale score for nasal obstruction was decreased from preoperative 7.63 ± 0.99 points to 3.88 ± 0.92 points (postoperative 3 months), 4.16 ± 0.78 points (postoperative 6 months), and 4.63 ± 0.69 points (postoperative 1 year). Six out of the eight patients were satisfied with the clinical outcome at 1 year after the procedure. To the best of our knowledge, coblation NSB reduction has not yet been reported in the medical literature. Our results show that it can be an effective treatment modality for nasal valve narrowing in patients with abnormally thickened NSB.

[Hypofibrinogenemia caused by hemocoagulase after endoscopic sinus surgery: a case report]

A 61 year-old male patient, plasma fibrinogen level was 2.98 g/L, endoscopic sinus surgery was performed under general anesthesia for polypoid of uncinate process with mycotic maxillary sinusitis. Hemocoagulase were given in pre- and post-operative for treatment. The patient was found postoperative drain blood continuously since 3 days after surgery, when the dose of hemocoagulase reach 26 KU, and fibrinogen determined in Plasma was 0.48 g/L. Coagulation returned to normal and nasal bleeding stopped after discontinuation of the hemocoagulase and supplement with fibrinogen.

[Septic shock in 23 year old female patient after surgical correction of the nasal septum effectively treated in the intensive care unit]

A female patient 23 years old was admitted to the medical intensive care unit due to sudden loss of consciousness and seizures. At the time of admition observed lack of consciousness, seizures and severe critical condition was observed. Meningitis and septic shock were diagnosed. Based on computed tomography performed on the first day--inflammation of the sinuses soft tissues was diagnosed. Suspected cause of infection was performed 6 weeks earlier surgical correction of the nasal septum. In the next stage of treatment on the seventh day after admission the functional endoscopic sinus surgery was performed. Due to massive tissue hypoperfusion the necrosis in the skin of the lower limbs occurred. Due to the lack of effectiveness antimicrobial therapy use of intravenous ceftaroline was administrated. Effective treatment allowed in day 11 to wean the patient from the ventilator. At the day 26 the patient was transferred to a hospital in the place of residence.

[Study on the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery]

OBJECTIVE

To evaluate the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery.

METHOD

In the randomized, double blind, controlled study, 120 patients undergoing septoplasty were divided into 3 groups (n = 40): group A received parecoxib 40 mg by muscle injection 30 min before the operation; group B received pentazocine 30 mg; group C received an equal volume of saline. The preemptive analgesia effect was evaluated with VAS scores which recorded at different time points. The proportion of participants using rescue analgesia after the operation were recorded as additional measures of preemptive analgesia.

RESULT

Intra-operative as well as the postoperative pain scores were less in the group A and group B than in the control group. Fewer participants required rescue medication after operation with parecoxib as well as pentazocine than placebo. However there were no difference in the preemptive effects between the group A and group B.

CONCLUSION

Administration of both the parecoxib and pentazocine before the nasal endoscopic surgery can provide preemptive analgesia without serious adverse side effects that deserves popularization in the clinic.

[Potential risk factors of excessive epistaxis after endoscopic endonasal surgery]

OBJECTIVE

To investigate the potential risk factors and management of excessive epistaxis after endoscopic endonasal surgery (EES).

METHOD

Six hundred and forty-one patients who underwent EES in our hospital from December 2011 to December 2012 were reviewed retrospectively. Factors which potentially affect the incidence of excessive epistaxis after EES were analyzed with univariate and multivariate logistic regression model.

RESULT

The incidence rate of excessive epistaxis after EES was 8.4% in our study. Multivariate logistic regression analysis revealed that history of previous EES, along with other four factors, correlated significantly with the occurrence of excessive epistaxis after EES.

CONCLUSIONS

Previous EES, along with other three factors, may increase the chance of excessive epistaxis after EES, while pre-operative corticosteroid therapy may reduce the risk to some extent.

[Orbital complication in endoscopic sinus surgery: a case report]

Acute and chronic infection of sinus could expand to orbital cavity. As the technique and equipment of endoscopic surgery are getting popular and renewal, endoscopic sinus surgery is being used widely and profoundly, which improves the surgical effect of nose and sinus diseases greatly. However, the complications are not decreased rather than traditional surgery. The rate of orbital complication is the highest of all endoscopic sinus surgery. This paper present a case report about orbital complication due to sinusitis or endoscopic sinus surgery and related literature were reviewed.

Univariate and multivariate analyses for postoperative bleeding after nasal endoscopic surgery

CONCLUSIONS

Our study suggested that the major risk factors for postoperative bleeding after nasal endoscopic surgery (NES) included hypertension, long-term non-steroidal anti-inflammatory drugs (NSAIDs), and previous nasal surgery. The use of preoperative corticosteroids is a valuable measure for reducing postoperative bleeding after NES.

OBJECTIVES

To explore risk factors for postoperative bleeding after NES and find effective measures to reduce or prevent the condition.

METHODS

A total of 641 patients who underwent NES were analyzed retrospectively. Univariate analysis and logistic regression were performed to find potential risk factors.

RESULTS

The incidence of postoperative bleeding after NES was 8.4%. Multivariate logistic regression analysis revealed that the occurrence of postoperative bleeding after NES was positively associated with hypertension, long-term NSAIDs, previous NES, and modified submucosal septoplasty, but negatively associated with the use of preoperative corticosteroids.

[Kaino-sinus syndrome: a case report]

Kaino-sinus syndrome is one new complication of endoscopic sinus surgery. The patient had an operation of endoscopic surgery, because he was suffered from an illness of frontal nasal inverted papilloma again. After operation he was suffering pain in left epicanthal folds and frontal part, and had dry scab in nasal cavity when he breathed cold air. The symptoms could relieve by blocking prenaris. We found he had a big aperture of frontal sinus and dry scab in nasal endoscopic examination. His symptoms disappeared after cleaning and washing accessory nasal cavity by salt water.

[Complications of endoscopic nasal and sinus surgery: experience in 150 patients]

BACKGROUND

Endoscopic nasal and sinus surgery has been used greatly for the treatment of inflammatory and neoplasm pathology, as well as for the approach of the extrasinus structures. Although it has proven to be a very successful method, it is not exempt of complications. Our objective was to identify the frequency of complications in patients with sinus and nasal pathology that underwent an endoscopic surgery of the nose and sinuses.

METHODS

A total of 150 patients who underwent endoscopic sinus surgery, 75 women and 75 men, in a specialties hospital of the Instituto Mexicano del Seguro Social (IMSS). The type of pathology, surgical technique done, major and minor adverse event presented were recorded.

RESULTS

We observed an overall complication rate of 18 %: 2.7 % corresponded to major, and 15.3 % to minor. The main pathologies were chronic rhinosinusitis without polyps (24.7 %) and sinus nasal tumors (22 %).

CONCLUSIONS

The overall complications and the major rates were similar to those reported in the literature. On the other hand, the minor adverse events were slightly higher. Still, endoscopic surgery has become a safe surgical treatment option.

[Analysis of intracranial infection factors after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea]

OBJECTIVE

To analyze the factors of intracranial infection after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea.

METHODS

One hundred and seventy-three patients who accepted transnasal endoscopic repair of cerebrospinal fluid rhinorrhea were retrospectively analyzed. The intracranial infection factors was analyzed by Logistic regression analysis with SPSS 17.0 software.

RESULTS

Postoperative infection was found in 17 cases among 173 patients, the infection rate was 9.83%. The unsuccessful transnasal endoscopic repair of cerebrospinal fluid rhinorrhea (χ(2) = 6.89, P = 0.001) , the defective diameter of skull base (χ(2) = 9.98, P = 0.001) and medical history of intracranial infection (χ(2) = 11.08, P = 0.001) were infection factors after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea (all P < 0.05), while sex, age, the site of defection, the aetiological agent, longer application of antibiotics before or after operation and the use of artificial material had no obvious effect (all P > 0.05).

CONCLUSION

Intracranial infection after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea is affected by many factors, such as the unsuccessful transnasal endoscopic repair of cerebrospinal fluid rhinorrhea, the defective diameter of skull base and medical history of intracranial infection.

[The potential of simultaneous surgery in rhinology]

The objective of the present work was to analyse the results of simultaneous rhinosurgical interventions and substantiate the possibility of their wider application for the improvement of the outcomes of the treatment of the patients presenting with diseases of the nose and paranasal sinuses. The clinical observations of 1661 patients following rhinosurgical operations are reported. Simultaneous interventions were performed on 756 of them (45.5%); their classification and character are described. The advantages of one-step rhinosurgery are discussed, the relevance and good prospects for the more extensive application of this approach are emphasized.

[Post operative Caldwell-Luc procedure maxillary cyst: Report of a case]

Rare complication of radical surgery (Caldwell Luc procedure) of the maxillary sinus, maxillary cyst can occurred several years after. We describe the case of a patient 56 years old, who came to our consultationfor repeated pain in the right maxillary region with moderate facial asymmetry. In her history we noted a previous sinus surgery (Caldwell Luc) more than 10 years before. The imaging showed an expansive process filled with proteinic tissue of the posterior wall of the maxillary. With the history of the former surgery, we suspected the existence of a mucocele. She underwent an endonasal surgery and the pathological examination of the specimen revealed an intra osseous cyst lined with ciliated respiratory type mucosa post surgery of the maxillary sinus. The diagnosis of a maxillary cyst complicating a Caldwell Luc was established based on the results obtained with the clinico-radiological and pathological results.

[Clinical study of analgesic effect of lornoxicam in nasal packing]

OBJECTIVE

To explore the pain control effect of lornoxicam on patients after nasal packing.

METHOD

A total of 56 patients undergoing nasal packing between January 2011 and August 2011 were randomly divided into the treatment group and control group. (1) Treatment group: routinely given lornoxicam for injection 8 mg(2 ml), intravenous injection, twice a day; (2) CONTROL GROUP: given saline 2 ml, intravenous injection, twice a day, other treatments are the same with the treatment group. Visual analog scale was used to record the painful severity of nose and head at 3, 6, 12, 24 and 48 h,and record the sleep quality score at 24 and 48 h.

RESULT

The pain in nose and head and night sleeping in treatment group were all significantly better than that in control group.

CONCLUSION

The analgesic effect of lornoxicam in nasal packing is good, with no evident adverse reactions.

Acellular dermal (alloderm) grafts versus silastic sheets implants for management of empty nose syndrome

The objective of the study is to conduct a prospective randomized blind clinical study comparing the efficacy and safety of use of acellular dermal (alloderm) grafts versus silastic sheets submucosal implants for management of empty nose syndrome (ENS). A total of 24 patients with a clinical diagnosis of ENS were randomly distributed in two equal groups: silastic implant group and alloderm implant group according to the type of implant used to rebuild the nose. This implant was inserted in submucoperichondrial and/or submucoperiosteal pockets fashioned along the septum, nasal floor, and lateral nasal wall. Subjective evaluation was done by reviewing the Sino-Nasal Outcome Test (SNOT-25), while objective evaluation was done by anterior rhinoscopy and nasal endoscopy. Both groups experienced a significant improvement after surgery (the mean SNOT-25 score before implantation was 61.4 compared to 33.6 after implantation in silastic implant group, while in alloderm implant group, it was 63.7 before surgery compared to 34.2 after implantation). There was no statistical evidence for a significant difference between the two groups. Objective evaluation showed rapid healing with no signs of implant infection, rejection, or allergic reaction in both groups. Both graft materials are well suited to this procedure with no statistical evidence for a significant difference between them. The silastic implant is inert and yet incorporated into the surrounding tissue because of the fashioned macropores. It is available and inexpensive. Acellular dermis graft is reliable, predictable, and readily shaped. Patients of both groups showed marked subjective and objective improvements. The surgical procedure is safe and relatively simple to perform.

[The efficacy of medical care following modified rhinosurgical interventions]

The objective of the present study was to evaluate the efficacy of medical aid after modified rhinosurgical interventions with the use of the methods for the objective assessment of the normalization of the nasal function and the patients' quality of life during the treatment. A total of 38 patients presenting with deviation of the nasal septum and persistent disturbances of the nasal breathing were examined and treated to estimate the quality of the medical aid following modified rhinosurgical interventions. The study has demonstrated the high quality of medical care for the patients undergoing modified rhinosurgical interventions which is the leading criterion for the treatment of the subjects suffering diseases of the nasal cavity.

[The treatment of chronic polypous rhinosinusitis in the postoperative period with low doses of clarithromycin]

The aim of this work was to study efficacy and safety of long-term low-dose clarithromycin therapy of chronic polypous rhinosinusitis during 6 months after endoscopic polyposinusotomy. 112 patients aged 25-65 yr were randomized in groups 7 days after surgery. Those in group 1 (n=66) received topic corticosteroid treatment in combination with clarithromycin (250 mg/day for 3 mo). The use of clarithromycin significantly decreased the number of clinical symptoms and improved quality of life. CT examination showed significant reduction in the frequency of relapses, episodes of acute respiratory viral infections, and their bacterial complications. All these effects persisted for 3 mo after withdrawal of clarithromycin.

[The correction of Eustachiantube dysfunction after microscopic rhinological surgical interventions by prolonged transtubal drainage]

The objective of the present study was to analyse the results of he treatment of Eustachian tube dysfunction by means of prolonged transtubal drainage of the tube lumen using a polyethylene catheter introduced immediately after the completion of the rhinosurgical intervention for the targeted delivery of pharmaceutical products. Eighty four patients with Eustachian tube dysfunction and impairment of hearing had a thin catheter introduced in the tube lumen for 7-14 days after various rhinosurgical interventions. We estimated the efficacy of the local treatment following rhinosurgery with the subsequent prolonged administration of pharmaceutical products through the intratubal drainage system. It is concluded that the introduction of a thin polyethylene drainage in the Eustachian tube lumen immediately after the rhinosurgical intervention combined with subsequent prolonged local pharmacotherapy make it possible to achieve the long-term recovery of the tube function in 80% of the patients.

[The surgical strategy for the treatment of intraoperative ruptures of nasal septal mucosa (part 1)]

The objective of the present study was to develop the surgical strategy for the management of intraoperative ruptures of nasal septal mucosa. The paper highlights etiology and pathogenesis of postoperative perforations of the nasal septum. The intraoperative ruptures of nasal septal mucosa were shown to be the major factors responsible for the enhanced risk of nasal septum perforation. A total of 188 patients presenting with unilateral linear intraoperative ruptures of nasal septal mucosa that occurred in the course of the septoplastic intervention were available for the observation during a period from 2009 to 2011. The study has demonstrated that the defects in intranasal mucosa developing in the late postoperative period cause a sustained collapse of the mucociliary activity. The up-to-date techniques were used to develop the surgical strategy for the treatment of intraoperative ruptures of nasal septal mucosa depending on their length and character. An original method is proposed for fixing mucoperichondrial flaps for the plastic closure of the intraoperative defects of nasal septal mucosa. The results of the study provided a basis for the development of practical recommendations to be used by otorhinolaryngologists for the purposes of both septoplasty and plastic closure of perforations in the nasal septum.