Potential conflict of interest: None provided.
Meta-analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery
Version of Record online: 16 DEC 2012
© 2012 ARS-AAOA, LLC
International Forum of Allergy & Rhinology
Volume 3, Issue 6, pages 482–487, June 2013
How to Cite
How to Cite this Article: Meta-analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery. Int Forum Allergy Rhinol, 2013; 3:482–487., ,
A.J.K. and F.G.P. contributed equally as first authors.
- Issue online: 25 JUN 2013
- Version of Record online: 16 DEC 2012
- Manuscript Accepted: 25 SEP 2012
- Manuscript Revised: 5 SEP 2012
- Manuscript Received: 14 MAR 2012
- intraoperative blood loss;
- operative time;
- mean arterial pressure
Functional endoscopic sinus surgery (FESS) has been used as the standard of treatment for sinonasal disease in which medical therapy fails to ameliorate the disease. Intraoperative hemostasis is a crucial factor in FESS. Currently, ideal techniques for creating intraoperative hemostasis have yet to be clarified and standardized. We sought to better understand what variables can affect intraoperative blood loss and therefore improve surgical field outcomes.
A literature search was conducted using PubMed, OVID, MD Consult, and Micromedex with keywords including: FESS, intraoperative blood loss, hemorrhage, and vasoconstriction. The articles were then evaluated with regard to blood loss, surgical grade, and operative time. Eleven articles were cross-referenced to determine the most statistically significant techniques in 3 main categories: general anesthetics, preoperative steroids, and use of epinephrine.
Analysis of the articles indicate that total intravenous anesthesia (TIVA) is statistically more beneficial than balanced anesthesia (BA), providing an average difference in blood loss of 75.3057 mL; the use of preoperative steroids is statistically more beneficial than placebo, with an improved difference in blood loss of 28 mL; and a trend toward hemostasis with the use of local anesthetics at a concentration of 1:200,000.
Meta-analysis of 1148 patients concludes that hemostasis during FESS is best conducted using TIVA, preoperative steroids, and topical local anesthetic at a 1:200,000 concentration.