Vinod, P (2015) Compare the effectiveness of normal saline to adrenaline (1:100000) in reducing intra operative bleeding following pterygopalatine fossa infiltration prior to performing endoscopic sinus surgery. Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVES: 1. To evaluate and compare the effectiveness of normal saline to normal saline with 1:100000 adrenaline infiltration in pterygopalatine fossa during endoscopic sinus surgery. 2. To assess and compare the following hemodynamic variables : - Heart Rate and Mean Arterial Pressure. - Effect of mean arterial pressure on Visual surgical grade. - Effect of mean heart rate on Visual surgical grade. METHODS OF STUDY: The subjects who presented to the ENT outpatient clinic with nasal complaints underwent detailed ENT examination including rigid nasal endoscopy and CT scan of the paranasal sinuses. Patients were recruited for the study if they satisfied the inclusion and exclusion criteria. A written informed consent was obtained from every patient. The transoral infiltration of the pterygopalatine fossa was administered by the operating surgeon such that one side would be infiltrated with 2 ml of either normal saline with 1:100000 adrenaline or normal saline. On completion of procedure on one side the opposite side was infiltrated with 2 ml of the second solution. Principal investigator graded the intra operative bleed according to Wormald surgical field scale and was blinded to the drug administered. Mean arterial pressure and heart rate were also recorded along with surgical grading. RESULTS: 1. Our study revealed a better surgical field on the side infiltrated with saline and adrenaline when compared to saline infiltration alone. 2. Heart rate and mean arterial pressure did not show any statistical significance with the quality of surgical field. 3. Initial hour proved crucial with a better surgical field being obtained with normal saline and 1in 1 lakh adrenaline. CONCLUSION: Our study compares the efficacy of pterygopalatine fossa infiltration with normal saline to normal saline with 1:100000 adrenaline, in reducing bleeding and thus providing a better surgical field. The study revealed a better surgical field on the side infiltrated with saline and adrenaline when compared to saline infiltration alone (p value < 0.01). The initial hour proved crucial as the maximum hemostatic effect was noticed in this hour. Heart rate and mean arterial pressure did not show any statistical significance with the surgical grade of bleeding on our study. The technique for attaining haemostasis in endoscopic sinus surgery is mutifactorial ; this may range from simple warm saline irrigations to use of gelatin matrix in achieving hemostasis. Infiltration of the pterygopalatine fossa is one of the many techniques that can be adopted to provide a better surgical field. It is our opinion that sheer tissue compression with saline infiltration may not suffice to provide a better surgical field; the vasoconstrictive effect of adrenaline does bear an impact on the final surgical field and outcome.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Pterygopalatine fossa ; Endoscopic sinus surgery. |
| Subjects: | MEDICAL > Otolaryngology |
| Depositing User: | Devi S |
| Date Deposited: | 07 Oct 2018 06:23 |
| Last Modified: | 07 Oct 2018 06:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9730 |
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