The safety and effectiveness of endoscopic rhinological operations in the treatment of chronic inflammatory diseases, as well as neoplasms of the paranasal sinuses, are largely achieved by reducing bleeding in the area of the surgical field. Even a small amount of blood can disrupt the view during endoscopy and prevent the intervention from being performed, thereby increasing the risk of complications.The review presents modern methods of reducing the risk of intraoperative bleeding under general anesthesia. Each approach has its own characteristics, therefore, the benefit-risk ratio should be assessed for each patient before choosing a specific method for controlling intraoperative bleeding.
Эндоскопическая риносинусохирургия может быть связана с развитием таких осложнений, как повреждение зрительного нерва, повреждение твердой мозговой оболочки, менингит и развитие летального исхода. Интраоперационная управляемая гипотония может снизить риск развития серьезных осложнений в результате плохой визуализации операционного поля. Цель исследования: оценить влияние способа обеспечения проходимости дыхательных путей на видимость операционного поля и выраженность интраоперационного кровотечения при эндоскопической риносинусохирургии. Исследовано 57 случаев эндоскопических риносинусохирургических вмешательств. В 1-й группе (n=29) устанавливалась ларингеальная маска, во 2-й группе (n=28) выполнялась интубация трахеи. Для снижения степени кровотечения применяли управляемую гипотонию. От момента начала операции управляемая гипотония была достигнута быстрее в 1-й группе. Видимость операционного поля в первые 15 мин оперативного вмешательства была лучше в 1-й группе, далее показатели кровоточивости не имели статистически значимых отличий. Применение ларингеальной маски для обеспечения проходимости дыхательных путей при эндоскопической риносинусохирургии в условиях общей анестезии улучшает обозримость операционного поля, снижает выраженность интраоперационного кровотечения. При этом повышается безопасность оперативного вмешательства. Ключевые слова: общая анестезия, управляемая гипотония, ларингеальная маска, интубация трахеи, риносинусохирургия.
The objective: to assess the incidence and influence of platelets level on the hemorrhagic complications during percutaneous dilated tracheotomy (PDT) in patients with thrombocytopenia.Subjects and Methods. The study included 85 consecutive patients with varying degrees of thrombocytopenia at the stages of hematopoietic stem cell transplantation. The control group included 56 patients who underwent classical tracheotomy. The study group included 29 patients who underwent PDT (Griggs method). The operations were performed for prolonged artificial pulmonary ventilation. When the platelets level was below 20 × 109/L, platelet concentrate transfusion was performed before the operation.Results. The incidence of hemorrhagic complications in patients with thrombocytopenia during PDT was 13.8% (95% CI 9.13–18.45%). In open tracheotomy, the bleeding rate was 3.8% (95% CI 2.65–4.49%). These results are comparable to the incidence of hemorrhagic complications in patients with normal platelet counts. The influence of the platelet level on the presence of hemorrhagic complications in both groups was not established.Conclusion. Thrombocytopenia is not a contraindication to performing PDT. However, platelet concentrate transfusion should be performed in patients with platelet counts less than 20 × 109/L. An experienced team of anesthesiologists and endoscopists can reduce the incidence of other complications.
The article presents the practical aspects of jet ventilation (JV) methods usage during the anesthesiological support of endolaryngeal operations. The recommendations for the selection of JV methods and regimes subject the form of pathologic object, degree of its manifestation, localization, and also mode of endosurgical operation are given. The possibilities of JV complications prevention are discussed.
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