European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 9, pp 2451–2454 | Cite as

Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a pre-operative single dose versus a 5-day course of corticosteroid

  • Saeid Atighechi
  • Mohammad Reza Azimi
  • Seyyed Abbas Mirvakili
  • Mohammad Hossein Baradaranfar
  • Mohammad Hossein Dadgarnia
Rhinology

Abstract

Nasal polyps are associated with the inflammation of the nasal cavity and the sinus mucosa. When medical treatment cannot solve a patient’s problem, a functional endoscopic sinus surgery may be indicated. Bleeding impairs the surgery field during operation and increases the operation risk and time. Pre-operative corticosteroids can reduce bleeding during surgery. In this study, we have evaluated the effect of pre-operative single-dose prednisolone (1 mg/Kg/dose 24 h before surgery) versus 5-day prednisolone (1 mg/Kg/day before operation) on the bleeding volume and the surgery field quality during FESS. In this mono blind randomized clinical trial, 80 patients with bilateral nasal polyps were randomly assigned in two groups. The first group (A) received a single dose of 1 mg/Kg/dose prednisolone on the day before the surgery. The second group (B) received 1 mg/Kg/day prednisolone for 5 days before the operation. The patients were operated on under general anesthesia through the same protocol. The mean arterial blood pressure was 70–80 mm Hg in both groups. The surgeons were not aware of the patients’ group. The bleeding volume and the surgeons’ opinion about the surgery field quality were recorded at the end of the procedure and analyzed by Chi-square and t test. The two groups were not significantly different in their overall demographic and clinical characteristics. The mean bleeding volume during the operation was 266.5 ± 96.31 ml in group A and 206 ± 52.81 ml in group B; there was a significant difference between the groups (P value = 0.038). There was no significant difference between the groups in the surgeons’ opinion about the surgery field quality (P value = 0.09). In conclusion, unlike a single dose (1 mg/kg/dose), treatment with 5-day prednisolone (1 mg/kg/day) can reduce blood loss during FESS more efficiently and may improve the surgery field quality slightly. But this difference is not clinically significant.

Keywords

Nasal polyps Prednisolone Endoscopic sinus surgery Bleeding Complication Corticosteroids 

References

  1. 1.
    Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:3 (preceding table of contents, 1-298)PubMedGoogle Scholar
  2. 2.
    Damm M, Quante G, Jungehuelsing M et al (2002) Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 112(2):310–315PubMedCrossRefGoogle Scholar
  3. 3.
    Kirtsreesakul V (2004) Nasal polyps: the relationship to allergy, sinonasal infection and histopathological type. J Med Assoc Thai 87(3):277–282PubMedGoogle Scholar
  4. 4.
    Aukema AA, Mulder PG, Fokkens WJ (2005) Treatment of nasal polyposis and chronic rhinosinusitis with fluticasone propionate nasal drops reduces need for sinus surgery. J Allergy Clin Immunol 115(5):1017–1023PubMedCrossRefGoogle Scholar
  5. 5.
    Mullol J, Obando A, Pujols L et al (2009) Corticosteroid treatment in chronic rhinosinusitis: the possibilities and the limits. Immunol Allergy Clin North Am 29(4):657–668PubMedCrossRefGoogle Scholar
  6. 6.
    Dykewicz MS, Hamilos DL (2010) Rhinitis and sinusitis. J Allergy Clin Immunol 125(2 Supplement 2):s103–s115PubMedCrossRefGoogle Scholar
  7. 7.
    Lal D, Stankiewicz JA (2012) Primary sinus surgery. In: Flint PW, Haughey BH, Lund VJ et al (eds) Cummings otolaryngology, head and neck surgery. Mosby Elsevier, Philadelphia, p 743Google Scholar
  8. 8.
    Albu S, Gocea A, Mitre I (2010) Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery. Otolaryngol Head Neck Surg 143(4):573–8PubMedCrossRefGoogle Scholar
  9. 9.
    Giordano J, Darras J, Chevalier D et al (2009) Preoperative corticosteroid treatment and nasal polyposis. Ann Otolaryngol Chir Cervicofac 126(3):120–124PubMedCrossRefGoogle Scholar
  10. 10.
    Kirtsreesakul V, Wongsritrang K, Ruttanaphol S (2011) Clinical efficacy of a short course of systemic steroids in nasal polyposis. Rhinology 49(5):525–532PubMedGoogle Scholar
  11. 11.
    Bolanos SH, Khan DA, Hanczyc M (2004) Assessment of mood states in patients receiving long-term corticosteroid therapy and in controls with patient-rated and clinician-rated scales. Ann Allergy Asthma Immunol 92:500–505PubMedCrossRefGoogle Scholar
  12. 12.
    Sieskiewicz A, Olszewska E, Rogowski M et al (2006) Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis: a preliminary investigation. Ann Otol Rhinol Laryngol 115(7):490–494PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Saeid Atighechi
    • 1
    • 2
  • Mohammad Reza Azimi
    • 1
  • Seyyed Abbas Mirvakili
    • 1
  • Mohammad Hossein Baradaranfar
    • 1
  • Mohammad Hossein Dadgarnia
    • 1
  1. 1.Department of OtolaryngologyShahid Sadooghi University of Medical SciencesYazdIran
  2. 2.Department of OtolaryngologyShahid Sadooghi HospitalYazdIran

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