Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial

Gan, Eng Cern; Alsaleh, Saad; Manji, Jamil; Habib, Al‐Rahim; Amanian, Ameen; Javer, Amin R.

doi:10.1002/alr.21376

Cited by 48 publications

(108 citation statements)

References 23 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, Ozmen et al found in a randomized controlled trial of 120 children that 500C saline solution was substantially better than room-temperature saline to obtain postadenoidectomy hemostasis (7) . This is in accordance with findings from two studies showing that hot saline irrigation during functional endoscopic sinus surgery reduced blood loss compared to irrigation with room temperature saline (8,9) . Despite, the promising results from Novoa et al, there is still limited use of water irrigation in clinical practice.…”

Section: Introductionsupporting

confidence: 92%

“…The suggested threshold temperature of 520C for mucosal tissue necrosis was derived from an experimental study in rabbits (10) . More recent human studies on hot water irrigation, have all used water temperatures of 500C or less and tissue necrosis has not been reported (6,7,(11)(12)(13)(14)(15) . Specifically, in the study from Schlegel-Wagner et al patients were examined between 4 and 24 months after 500C hot water irrigation for epistaxis without signs of mucosal injury (12) .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

In vitro surface temperature of nasal balloons during hot water inflation

Moene¹,

Hauge²,

Silvola³

et al. 2019

RHINOL

View full text Add to dashboard Cite

Background: Posterior epistaxis is often treated with nasal packing by balloon compression or gauzes, and in refractory cases, with ligation of the sphenopalatine artery. These methods are painful, require admission and imply a substantial risk of complications. It has been shown that hot water irrigation is effective to stop bleeding. However, the hot water procedure is associated with patient discomfort, and temperatures over 520C may cause tissue necrosis. The use of nasal balloons filled with hot water may potentially be equally effective and cause less discomfort, but has not yet been studied. The aim of this study was to determine the surface temperature of nasal balloons when filled with hot water. Methodology: An in vitro study was performed to determine surface temperature of Epistat® and Rapid Rhino® nasal balloons when filled with water at different temperatures. Results: There was a strong correlation between inserted water temperature and maximum temperature at Epistat® balloon surface. Maximum surface temperature occurred during the first 30 seconds after water insertion and there was a rapid temperature decline irrespective of inserted water temperature. There was a similar correlation for Rapid Rhino®. However, surface temperatures were in general lower, maintained for a longer period and the peak temperature occurred later. Conclusions: Hot water inflation in nasal balloons seems to be feasible and is unlikely to cause tissue necrosis with inserted water temperatures of 600C or less.

show abstract

Section: Introductionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

In vitro surface temperature of nasal balloons during hot water inflation

Moene¹,

Hauge²,

Silvola³

et al. 2019

RHINOL

View full text Add to dashboard Cite

show abstract

“…Saline delivered at a temperature of 49 C demonstrated a beneficial impact on surgical field for cases lasting longer than 2 hours. 31 The types of anesthetic and degree of hemodynamic control have also been suggested to influence intraoperative blood loss and visualization. Several studies have suggested that total intravenous anesthesia reduces peripheral vasodilation and improves the quality of the surgical field, whereas other reports have found no improvement; therefore, further investigation is warranted.…”

Section: Intraoperative Phasementioning

confidence: 99%

Avoiding Complications in Endoscopic Sinus Surgery

Humphreys

Hwang

2015

Otolaryngologic Clinics of North America

View full text Add to dashboard Cite

“…Multiple methods have been described to improve visualization and decrease bleeding including use of total intravenous anesthesia [6,7], local infiltration with epinephrine [11], topical decongestants [12], head of bed elevation [5], warm water irrigation [13], greater palatine canal injection with epinephrine [14], and preoperative oral steroid therapy [4]. Recent data demonstrating the safety of concentrated topical epinephrine indicates that it is safe, minimizes blood loss and potentially obviates the need for oral steroid use [8].…”

Section: Discussionmentioning

confidence: 99%

Benefit of Preoperative Oral Steroids during Sinus Surgery when Utilizing Concentrated Topical Epinephrine

Korkmaz

Yao

Korkmaz

et al. 2016

ORL

View full text Add to dashboard Cite

Background/Aims: Oral steroids have been advocated in the preoperative setting as a means of reducing intraoperative blood loss and surgical time during sinus surgery. The purpose of this study was to analyze the impact of preoperative oral steroid administration on intraoperative bleeding and surgical duration when coupled with concentrated topical epinephrine. Methods: The medical records of 302 patients who underwent bilateral ‘full house' sinus surgery were reviewed. Concentrated topical epinephrine and inhalational anesthesia was used in all patients. Surgical duration and estimated blood loss were compared between the preoperative steroid-exposed and steroid-naive groups. χ² and Student's t tests were used for statistical analysis. Results: One hundred and forty-two patients were exposed to steroid, while the remaining 160 were steroid naive. No significant differences were found with respect to surgical time between the steroid-exposed (96.91 ± 25.97 min) and steroid-naive patients (91.24 ± 32.29 min, p = 0.100). The steroid-exposed group demonstrated a marginally increased blood loss (66.03 ± 55.81 ml) as compared to steroid-naive patients (55.00 ± 38.71 ml, p = 0.048). Conclusion: When coupled with intraoperative concentrated topical epinephrine use, preoperative oral steroid administration provides no clinically significant benefit with respect to reduced intraoperative bleeding or surgical duration.

show abstract

Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial

Abstract: HSI may be beneficial in improving surgical field of view in FESS after 2 hours of operating time. A significant reduction in rate of blood loss may be attained with HSI.

Cited by 48 publications

References 23 publications

In vitro surface temperature of nasal balloons during hot water inflation

In vitro surface temperature of nasal balloons during hot water inflation

Avoiding Complications in Endoscopic Sinus Surgery

Benefit of Preoperative Oral Steroids during Sinus Surgery when Utilizing Concentrated Topical Epinephrine

Contact Info

Product

Resources

About