Background: Intranasal topical 1:1000 epinephrine has been used safely and effectively for hemostasis during endoscopic sinus surgery (ESS). Prior studies assessing hemodynamic changes after intranasal topical epinephrine application have only used soaking wet cottonoid pledgets, and have only assessed for hemodynamic changes before any surgery being performed. Objective: The purposes of this study were to determine whether intranasal application of topical 1:1000 epinephrine with wrung-out cottonoid pledgets caused significant hemodynamic changes both before and during ESS, and whether it allowed for adequate hemostasis. Methods: A prospective evaluation of 30 patients with eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) undergoing complete bilateral ESS was conducted. Heart rate, blood pressure (systolic, diastolic, and mean arterial pressure), and electrocardiography changes were recorded at 0, 1, 2, and 5-minute intervals after placing wrung-out epinephrine-saturated pledgets, both before and at the end of ESS. No submucosal epinephrine injections were performed. Estimated blood loss (EBL) and major intraoperative complications were recorded for all cases. Results: There were no significant hemodynamic changes or electrocardiographic abnormalities after placement of wrung-out epinephrine-soaked pledgets both before and after ESS. After bilateral ESS, there were actually mean decreases in heart rate and blood pressure parameters. Mean EBL was 75.8 ± 32.2 mL, and no major intraoperative complications occurred. Conclusion: Intranasal application of topical 1:1000 epinephrine via wrung-out cottonoid pledgets was effective for intraoperative hemostasis, and did not cause clinically significant alterations in hemodynamic parameters or cardiovascular events, either before or during ESS in patients with CRSwNP. Level of Evidence: 4
Background: Conventional measures of scholarly impact derived from citation count do not account for academic readership and do not measure impact on the nonacademic audience (ie, the general population that does not engage in scholarship). To more broadly characterize attention received by research articles, alternative measures have been developed, including Mendeley readership and Altmetric Attention scores. Together, these metrics reflect academic readership and the effects of research in mainstream media. Characterizing articles that score highly according to these alternative measures is of interest to facial plastic surgeons, especially those who aim to disseminate their work to broad audiences. Objectives: To identify characteristics of facial plastic surgery articles associated with increased attention from both academic and nonacademic audiences. Methods: The top 50 most-cited articles with a facial plastics focus published since 2009 were categorized according to various themes. Article attention was assessed using conventional and alternative bibliometric indices. Pearson correlation matrix assessed associations between indices. Rank order congruence between indices was also assessed. MANOVAs assessed the overall effect of article theme on scholarly impact. Multiple one-way ANOVAs assessed effect of theme on individual indices. Results: Citation count, Mendeley readership, and Altmetric mentions all showed significant positive correlation with citations per year ( P < .05, P < .01, P < .01, respectively). Citations/year was most congruent with total citations (50% congruence). Articles focused on “lower face” received significantly more Mendeley readership than those focused on “head and neck” ( P = .009). Articles focused on “cosmetics” had significantly more citations/year ( P = .018) and Altmetric mentions ( P = .015) than those focused on “reconstruction.” Conclusion: The facial plastic research articles that received the most attention from both academic and nonacademic audiences were those focused on cosmetics. Additionally, articles pertaining to the lower face received more academic attention than those pertaining to head and neck.
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