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Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial
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 chron...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392372/ https://www.ncbi.nlm.nih.gov/pubmed/36000037 http://dx.doi.org/10.1002/lio2.841 |
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author | Akbarpour, Maliheh Jalali, Mir Mohammad Akbari, Maryam Haddadi, Soudabeh Fani, Ghaffar |
author_facet | Akbarpour, Maliheh Jalali, Mir Mohammad Akbari, Maryam Haddadi, Soudabeh Fani, Ghaffar |
author_sort | Akbarpour, Maliheh |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9392372 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley & Sons, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93923722022-08-22 Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial Akbarpour, Maliheh Jalali, Mir Mohammad Akbari, Maryam Haddadi, Soudabeh Fani, Ghaffar Laryngoscope Investig Otolaryngol Allergy, Rhinology, and Immunology 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. John Wiley & Sons, Inc. 2022-06-24 /pmc/articles/PMC9392372/ /pubmed/36000037 http://dx.doi.org/10.1002/lio2.841 Text en © 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Allergy, Rhinology, and Immunology Akbarpour, Maliheh Jalali, Mir Mohammad Akbari, Maryam Haddadi, Soudabeh Fani, Ghaffar Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial |
title | Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial |
title_full | Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial |
title_fullStr | Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial |
title_full_unstemmed | Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial |
title_short | Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial |
title_sort | effect of desmopressin on bleeding during endoscopic sinus surgery: a randomized clinical trial |
topic | Allergy, Rhinology, and Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392372/ https://www.ncbi.nlm.nih.gov/pubmed/36000037 http://dx.doi.org/10.1002/lio2.841 |
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