Nasal Desmopressin Versus Topical Epinephrine in Endonasal Dacryocystorhinostomy
Study Details
Study Description
Brief Summary
Dacryocystorhinostomy aims to create a channel between the lacrimal sac and nasal mucosa to relieve nasolacrimal duct occlusion. General anesthesia is still preferred by many surgeons to secure the airway and control blood pressure. Bleeding even minor can obscure the surgical field. This can extend the operative time & increase the failure rate. The hemostatic effect of desmopressin on the quality of the surgical field was investigated in patients undergoing endoscopic sinus surgery and revealed that desmopressin could reduce intraoperative bleeding.
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Detailed Description
Dacryocystorhinostomy aims to create a channel between the lacrimal sac and nasal mucosa to relieve nasolacrimal duct occlusion. General anesthesia is still preferred by many surgeons to secure the airway and control blood pressure. Bleeding even minor can obscure the surgical field. This can extend the operative time & increase the failure rate. The surgical field can be optimized by several techniques such as controlled hypotension, and local vasoconstrictors application, however, none of them can stand alone as a perfect choice for a bloodless surgical field. The hemostatic effect of intranasal desmopressin on the quality of the surgical field was investigated in patients undergoing endoscopic sinus surgery and revealed that desmopressin could reduce intraoperative bleeding. Hemostatic effects of desmopressin can be attributed to the rising in plasma levels of von Willebrand factor, coagulation factor VII and tissue plasminogen activator. Desmopressin also can play a role in improving platelet adhesiveness and stability of vascular endothelium. The topical application of 1:100,000 epinephrine is a common practice for intranasal surgical procedures. It decreases blood loss and improves endoscopic visualization. Up till now, no study compares nasal desmopressin and topical epinephrine effects on surgical field clarity and hemodynamics.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Desmopressin group The patient will receive two puffs of desmopressin acetate 10 µg/puff in the side of the nasal cavity ipsilateral to the obstructed lacrimal duct (20 μg totally) 60 minutes before surgery "Minirin 10 μg/0.1 ml per spray, Ferring Pharmaceutical Company". Three normal saline-soaked packs will be placed in the middle meatus for 5 minutes immediately before the start of surgery. |
Drug: Desmopressin Acetate Nasal, 10 μg/0.1 ml per spray
The patient will receive two puffs of desmopressin acetate 10 µg/puff in the side of the nasal cavity ipsilateral to the obstructed lacrimal duct (20 μg totally) 60 minutes before surgery.
Other Names:
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| Active Comparator: Epinephrine group The patient will receive topical 1:100,000 epinephrine in the side of the nasal cavity ipsilateral to the obstructed lacrimal duct via 3 soaked packs placed in the middle meatus for 5 minutes immediately before the start of surgery. The patient will also receive two puffs of normal saline "prepared in emptied Minirin bottle" in the same nasal cavity 60 minutes before surgery. |
Drug: Epinephrine topical 1:100,000 Nasal Packs
The patient will receive topical 1:100,000 epinephrine in the side of the nasal cavity ipsilateral to the obstructed lacrimal gland via 3 soaked packs placed in the middle meatus for 5 minutes immediately before the start of surgery.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Intraoperative blood loss [Measurement will be done at the 60th minutes of the start of surgery.]
Estimation of intraoperative blood loss will be done at 60th minutes of surgery by calculating the loss of blood and irrigation saline in 50 mL-graded suction canisters.
- The Surgical field clarity [at the end of surgery]
The quality of surgical field based on BOEZAART grading system(0 no bleeding; 1 slight bleeding: no suctioning is needed; 2 slight bleeding: occasional suctioning needed;, 3 sight bleeding: frequent suctioning required, bleeding threatens surgical field a few seconds after suction is removed; 4 moderate bleeding: frequent suctioning required and bleeding threatens surgical field directly after suction is removed; 5 severe bleeding: constant suctioning required)
- Change in Intraoperative hemodynamics [will be recorded at 10-min intervals for the first 2 hours of the start of surgery.]
Change in heart rate (HR), mean arterial blood pressure (MAP) and oxygen saturation (SaO2) from baseline.
- Change in serum sodium level [Serum sodium level will be measured preoperative, 12 hours and 24 hours postoperative.]
Serum sodium level will be measured pre & postoperative to detect and manage any sodium disturbances.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age: 18-45 years old.
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Physical status: ASA I & II.
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Type of operations: elective endonasal dacryocystorhinostomy under general anesthesia.
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Written informed consent from the patient.
Exclusion Criteria:
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Patient refusal.
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Known hypersensitivity to study drugs.
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Nasal pathology as active infection or an anatomical abnormality.
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Hyponatremia "serum Na+ less than 135".
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Coagulation disorders.
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Renal or cardiovascular disorders.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Zagazig University
Investigators
- Principal Investigator: Alshaimaa Abdel Fattah Kamel, MD, Assistant professor of Anesthesia, Intensive Care & Pain management,Zagazig University
Study Documents (Full-Text)
None provided.More Information
Publications
- Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995 May;42(5 Pt 1):373-6.
- Gruber RP, Zeidler KR, Berkowitz RL. Desmopressin as a hemostatic agent to provide a dry intraoperative field in rhinoplasty. Plast Reconstr Surg. 2015 May;135(5):1337-1340. doi: 10.1097/PRS.0000000000001158.
- Jahanshahi J, Tayebi E, Hashemian F, Bakhshaei MH, Ahmadi MS, Seif Rabiei MA. Effect of local desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple-blinded clinical trial. Eur Arch Otorhinolaryngol. 2019 Jul;276(7):1995-1999. doi: 10.1007/s00405-019-05435-3. Epub 2019 Jun 3.
- Korkmaz H, Yao WC, Korkmaz M, Bleier BS. Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery. Int Forum Allergy Rhinol. 2015 Dec;5(12):1118-23. doi: 10.1002/alr.21590. Epub 2015 Jul 8.
- Shao H, Kuang LT, Hou WJ, Zhang T. Effect of desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery: a randomized, clinical trial. BMC Anesthesiol. 2015 Apr 17;15:53. doi: 10.1186/s12871-015-0034-8.
- Vinciguerra A, Nonis A, Giordano Resti A, Ali MJ, Bussi M, Trimarchi M. Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases. Eur J Ophthalmol. 2022 Jan;32(1):66-74. doi: 10.1177/11206721211035616. Epub 2021 Jul 28.
- Nasal Desmopressin in DCR