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Systematic review of topical vasoconstrictors in endoscopic sinus surgery

Authors

  • Thomas S. Higgins MD, MSPH,

    1. Department of Otolaryngology and Head and Neck Surgery, Eastern Virginia Medical School, Norfok, Virginia, U.S.A.
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  • Peter H. Hwang MD,

    1. Department of Otolaryngology and Head and Neck Surgery, Stanford School of Medicine, Stanford, California, U.S.A.
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  • Todd T. Kingdom MD,

    1. Department of Otolaryngology and Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A.
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  • Richard R. Orlandi MD,

    1. Division of Otolaryngology and Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
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  • Heinz Stammberger MD,

    1. Department of Otorhinolaryngology and Head and Neck Surgery, Medical University Graz, Graz, Austria
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  • Joseph K. Han MD

    Corresponding author
    1. Department of Otolaryngology and Head and Neck Surgery, Eastern Virginia Medical School, Norfok, Virginia, U.S.A.
    • Eastern Virginia Medical School, Department of Otolaryngology and Head and Neck Surgery, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507
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  • The authors have no financial disclosures for this article.

  • The authors have no conflicts of interest to disclose.

Abstract

Objective:

The objective of this study is to systematically review the literature and examine the safety for the use of topical vasoconstrictors in endoscopic sinus surgery.

Study Design:

Systematic review clinical trials.

Method:

A systematic literature search was performed in MEDLINE, EMBASE, The Cochrane Library, and National Guideline Clearinghouse, and references in the selected articles.

Results:

The search criteria captured 42 manuscripts with relevant titles. A systematic review on the topical use of phenylephrine was found; however, no other systematic review, meta-analyses, or clinical guidelines were identified. Six randomized clinical trials or comparative studies, as well as multiple case reports and review articles were also identified. The literature supports the safety of oxymetazoline and epinephrine when used judiciously in carefully selected patients undergoing endoscopic sinonasal surgery; however, topical phenylephrine is not recommended because of its risk profile.

Conclusion:

In sinus or nasal surgery, topical vasoconstrictors should be used in a manner that minimizes the risk of cardiovascular morbidity.

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