Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Effect of Topical Furosemide Efficacy on Reducing Bleeding and Quality of Surgical Field During Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis

Document Type : Original

Authors
Javaneh Jahanshahi 1
Mohammad Ghorbani 1
Farnazf Hashemian 2
Farshad Hashemian 3
Mojghan Shekhi 4
Elham Khanlarzadeh 5
1 Department of Otolaryngology, School of Medicine, Hamadan, Hamadan, Iran.
2 Department of Otolaryngology, School of Medicine, Hamadan University of Medical Sciences, Iran.
3 Department of Clinical Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
4 Student of Drug Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
5 Department of Social Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
10.22038/ijorl.2022.57445.2973
Abstract
Introduction:
Bleeding during endoscopic sinus surgery has an unfavorable effect on the surgical field and prolongs the time of surgery. In this study, we assessed the efficacy of topical furosemide on bleeding and the quality of the surgical field during endoscopic sinus surgery.
Materials and Methods:
In this clinical trial, 76 patients with chronic rhinosinusitis were selected for endoscopic sinus surgery and randomly assigned to two groups, topical furosemide (intervention) and normal saline (control). The intervention group received 20 micrograms of intranasal spray twice daily, and the control group received regular intranasal saline spray, similar to the intervention group. In addition, the quality of the surgical field (scoring by the BOEZAART grading system) and the amount of bleeding during surgeries were measured. All data were analyzed.
Results:
In the intervention and control groups, the mean surgical bleeding volume was 187.70± 24.79 and 229.21± 28.18 ml (P <0.001), the mean of Boezaart scale 2 and 3 (P <0.001) and the mean of surgical time were 106.53±14.67 and 126.63 ± 15.42 minutes (P <0.001), respectively. In patients of the intervention group with and without polyps, the mean surgery time was 99.56± 12.15 and 118.84 ±10.03 minutes (P <0.001), and the mean bleeding volume during endoscopic sinus surgery was 176.46 ± 22.58, 208.46 ±12.14 ml (P <0.001) respectively.
Conclusions:
Our findings showed that nasal, topical furosemide spray significantly reduced the amount of bleeding during endoscopic sinus surgery and time of the surgery and improved the quality of the surgical field.
Keywords
Bleeding
Chronic rhinosinusitis
Endoscopic sinus surgery
Topical furosemide
Surgical field
Subjects
  1. Ocampo CJ, Peters AT. Antibody deficiency in chronic rhinosinusitis: epidemiology and burden of illness. American journal of rhinology & allergy. 2013;27(1):34-8.
  2. 2. Levine CG, Casiano RR. Revision Functional Endoscopic Sinus Surgery. Otolaryngologic clinics of North America. 2017;50(1):143-64.
  3. 3. Shao H, Kuang L-T, Hou W-J, 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 anesthesiology. 2015;15(1):1-5.
  4. 4. Kelly EA, Gollapudy S, Riess ML, Woehlck HJ, Loehrl TA, Poetker DM, editors. Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia. International forum of allergy & rhinology; 2013: Wiley Online Library.
  5. 5. Riegle EV, Gunter JB, Lusk RP, Muntz HR, Weiss KL. Comparison of vasoconstrictors for functional endoscopic sinus surgery in children. The Laryngoscope. 1992;102(7):820-3.
  6. 6. Wormald P-J, Athanasiadis T, Rees G, Robinson S. An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery. American journal of rhinology. 2005;19(3):288-92.
  7. 7. Kroflic B, Coer A, Baudoin T, Kalogjera L. Topical furosemide versus oral steroid in preoperative management of nasal polyposis. European Archives of Oto-Rhino-Laryngology and Head & Neck. 2006;263(8):767-71.
  8. Baradaranfar MH, Aghaei MA, Behniafard N, Nabi-Meibodi M, Atighechi S, Dadgarnia MH, et al. Effect of topical furosemide on intraoperative bleeding during functional endoscopic sinus surgery. Journal of Craniofacial Surgery. 2016;27(4):970-2.
  9. Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside-and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Canadian journal of anaesthesia. 1995;42(5):373-6.
  10. Rajguru R. Nasal polyposis: current trends. Indian Journal of Otolaryngology and Head & Neck Surgery. 2014;66(1):16-21
  11. 11. Hashemian F, Ghorbanian MA, Hashemian F, Mortazavi SA, Sheikhi M, Jahanshahi J, et al. Effect of Topical Furosemide on Rhinosinusal Polyposis Relapse After Endoscopic Sinus Surgery: A Randomized Clinical Trial. JAMA otolaryngology- head & neck surgery. 2016;142(11):1045-9.
Iranian Journal of Otorhinolaryngology
Volume 34, Issue 5
September and October 2022
Pages 219-224