Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial

Abstract

Background This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in Functional Endoscopic Sinus Surgery (FESS). Material and methods In a randomized clinical trial, patients referred for FESS to treat their bilateral chronic rhinosinusitis were recruited. The participants were adults (≥18 years). They were randomly assigned (1:1:1) to receive low‐dose (20 μg) or high‐dose (40 μg) intranasal desmopressin (DDAVP) or placebo 60 min before the induction of general anesthesia. Standard FESS was performed by the same surgeon. The primary outcomes were volume of intraoperative bleeding and the quality of surgical field. Clean surgical field was defined as a score ≤2 on the Boezaart grading system. Results A total of 120 patients were included on an intention‐to‐treat basis (mean age: 41.0 years; 40 women, 80 men). There were no significant differences in primary outcomes between low‐dose DDAVP and placebo. As for the volume of blood loss, however, there was a significant difference between high‐dose DDAVP and placebo (mean difference: 29.6 ml; adjusted Cohen's d: −1.02; p < .001). Also, in the high‐dose DDAVP, the probability of having a good surgical field over time was about two times higher than in the placebo group (RRs for first and second surgical sides: 1.89 and 2.18). The number needed to treat for the two time points was 1.6 and 1.3, respectively. Conclusion The present study showed that the use of desmopressin at a dose of 40 μg 1 h before surgery can reduce bleeding and improve the quality of the surgical field. Further studies are recommended to be able to generalize these findings to other ENT surgeries. Level of evidence 1b.

The effect of injection of 1:100 000 adrenaline solution in the pterygopalatine fossa on intra-operative bleeding during endoscopic sinonasal surgical procedures in chronic sinusitis: a blinded clinical trial

“…Although some have recommended this technique as an effective way of reducing blood loss during surgery, [2][3][4][11][12][13] we could not find any significant difference in bleeding between the study and control sides ( p = 0.49), similar to the results of Kumar et al 14 and Valdes et al 1 In a review paper by Shamil et al, in 2017, of seven articles, only two demonstrated a decrease in blood volume in the surgical field in the study group. 15 In contrast, Hwang and colleagues reviewed five articles, which were in favour of this method; additionally, the authors declared that the concentration of 1:80 000 adrenaline solution had a better result in comparison to 1:100 000.…”

“…Correction of coagulopathies, avoidance of predisposing medications in the pre-operative period, proper patient positioning, anaesthetic protocol, topical vasoconstriction, and some drugs like beta-blockers, tranexamic acid and desmopressin, are some of the preventive measures used to decrease blood in the surgical field. 2,3 There are limitations of beta-blocker usage in some patients (e.g. those with asthma); in addition, reports of blindness after the intranasal injection of vasoconstrictors, and limited accessibility of systemic and topical haemostatic agents, are encountered in some instances.…”

Desmopressin as a Treatment in Patients With Von Willebrand Disease: A Systematic Review

“…In a different study done by Akbarpour et al [ 18 ], a significant link was found between the type of surgery and the amount of blood loss. However, it is important to note that a mean difference of only 0.4 ml was found between the low-dose desmopressin group and the control group [ 18 ]. But when compared to the high-dose DDAVP group, the controls saw a 29.6 ml drop in bleeding during surgery.…”

“…But when compared to the high-dose DDAVP group, the controls saw a 29.6 ml drop in bleeding during surgery. The size of the resulting effect is a very important factor [ 18 ]. At both the first and second time points, the link between the type of surgery and the quality of the operating field was seen.…”

“…Due to the low quality of the data in this area, we still do not know how DDAVP affects overall blood loss. Also, previous studies have shown that people who have septorhinoplasty may lose less blood if they are given desmopressin [ 18 ].…”