Analysis the status and risk factors of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas / 中国实用护理杂志

Objective:To understand the status of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas and to explore its risk factors.Methods:By using the convenience sample way, a total of 413 patients in pituitary adenomas who were admitted to the endoscopic transsphenoidal resection from the Second Affiliated Hospital of Zhejiang University School of Medicine were selected as study objects from June, 2018 to December, 2019. The status questionnaire and factors questionnaire of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas was used to measure the status and factors of nasal bleeding. The risk factors were analyzed by single factor analysis andlogistic regression analysis.Results:There were 38 patients with nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas, with a incidence rate of 9.2%. Among them, 25 patients (65.8%) had precipitating factors of nasal bleeding, mainly sneezing and coughing (11 cases) and constipation (9 cases), and the bleeding season were mainly winter (13 cases) and autumn (14 cases), the average time of postoperative nasal bleeding occurred on the 13th day. The single factor analysis indicated that nasal bleeding related to hyperlipidemia, smoking, anticoagulants, constipation, intraoperative sphenoid artery injury, surgical approach (single and double nostrils), duration of surgery, nasal irrigation, red blood cells, platelets ( P<0.05). The Logistic regression analysis showed that anticoagulants, constipation, intraoperative sphenoid artery injury, nasal irrigation, platelets related to nasal bleeding ( P<0.05). Conclusion:The incidence of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas high, and have obvious triggers. The medical staff should focus on preoperative and intraoperative assessment, for the patients had anticoagulant history, constipation, low platelet and possible sphenoid artery and branch injury, should wary the nasal bleeding, nasal irrigation should used to reduce the risk of postoperative nasal bleeding.

Clinical observation of external dacryocystorhinostomy without packing anastomosis cavity / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To find an efficient and simple surgical procedure of the external dacryocystorhinostomy ( EXT- DCR) in the treatment of chronic dacryocystitis. METHODS:A total of 270 cases were performed in this retrospective study. A comparison of clinical effects and hemorrhage complications between the experimental group, in which 189 eyes of 167 patients that underwent traditional EXT-DCR without packing, and the control group, in which 121 eyes of 103 patients that underwent traditional EXT-DCR with Vaseline gauze were performed. The postoperative follow-up ranged from 6 to 36mo ( the mean follow-up was 15±3. 6mo). RESULTS: There were no significant differences in the curative rates between the two groups (97. 9% vs 97. 5%, P>0. 05). But the incidence rate of moderate or severe postoperative nasal bleeding was lower in the experimental group (15. 9%, 30 eyes) than the control group (31. 4%, 38 eyes) and PCONLUSION: The traditional EXT - DCR without packingis an effective procedure and is more effective in reducing moderate or severe postoperative bleeding when the intraoperative anastomose and the postoperative drainage are well done and the intraoperative bleeding is well controlled.

Transcatheter supperselective internal maxillary artery and facial artery embolization for treatment of intractable epistaxis / 中国介入影像与治疗学

Objective To investigate the clinical effects,complications and cautions for transcatheter supperselective internal maxillary artery and facial artery embolization for treatment of intractable epistaxis.Methods Eight patients with intractable epistaxis underwent transcatheter supperselective internal maxillary artery and facial artery embolization.Results Immediate hemostasis was obtained in all patients,while varying degrees of headache were observed,but no serious complications occurred.Conclusion Transcatheter supperselective internal maxillary artery and facial artery embolization is a safe,effective method for the treatment of intractable epistaxis.

Effective removal of epistaxis during nasotracheal intubation utilizing a fiberoptic scope in a difficult airway: A case report / 대한마취과학회지

Nasal bleeding related to nasal trauma is the most common complication of nasotracheal intubation with a fiberoptic scope. When nasotracheal intubation with a fiberoptic scope is performed, profuse bleeding from the nasal cavity makes it difficult to handle a fiberoptic scope and may cause a hypoxemia. So when nasal bleeding occurs, it is important to suction the nasal cavity for easy handling of a fiberoptic scope. But, it may be difficult to suction in a nasal cavity with a fiberoptic suction port only. We report a patient with nasal bleeding following nasotracheal intubation with a fiberoptic scope because of articular trismus, and successful nasotracheal intubation utilizing a fiberoptic scope by suctioning with an extra suction apparatus.

Effective removal of epistaxis during nasotracheal intubation utilizing a fiberoptic scope in a difficult airway: A case report / 대한마취과학회지

Nasal bleeding related to nasal trauma is the most common complication of nasotracheal intubation with a fiberoptic scope. When nasotracheal intubation with a fiberoptic scope is performed, profuse bleeding from the nasal cavity makes it difficult to handle a fiberoptic scope and may cause a hypoxemia. So when nasal bleeding occurs, it is important to suction the nasal cavity for easy handling of a fiberoptic scope. But, it may be difficult to suction in a nasal cavity with a fiberoptic suction port only. We report a patient with nasal bleeding following nasotracheal intubation with a fiberoptic scope because of articular trismus, and successful nasotracheal intubation utilizing a fiberoptic scope by suctioning with an extra suction apparatus.

The hemostasis in intractable posterior nasal bleeding with angiographic embolization: A case report

Does the Esophageal Stethoscope Inserted into the Reinforced Endotracheal Tube Decrease the Incedence of Nasal Bleeding following Nasotracheal Intubation? / 대한마취과학회지

BACKGROUND: Conventional nasotracheal intubation is commonly associated with injury to the passage tissues, such as the mucosal lining of the turbinates. Nasal polyp, teared mucosa and blood clots are potentially hazardous, since it lodge in a bronchus or obstruct a tracheal tube. So atraumatic intubation is very important point during nasotracheal intubation. METHODS: Fourty patients were divided into two groups, Mallinckrodt reinforced tube(n=20) and esophageal stethoscope inserted into the Mallinckrodt reinforced tube(n=20). The esophageal stethoscope was inserted into the Mallinckrodt reinforced tube until the distal end of the esophageal stethoscope reached about 5 mm beyond the distal end of the Mallinckrodt tube. The esophageal stethoscope was inflated using an air-filled syringe through a three-way stopcock. After defasciculating dose of pancuronium 0.5~1 mg intravenously, the patients were given thiopental 4~5 mg/kg, succinylcholine 1~2 mg/kg and lidocaine 1.5 mg/kg with 100% oxygen ventilation via face mask. After lubrication of the appropriate tracheal tube with jelly, it was gently advanced beyond the nasopharynx. The tube tip was manipulated into the larynx with the aid of a Magill intubating forceps. The incidence of epistaxis was compared between the two groups. RESULTS: The esophageal stethoscope inserted into the reinforced tube group had a significantly lower incidence of nasal bleeding than reinforced tube only (1/20 vs 18/20 : P<0.01). CONCLUSIONS: The esophageal stethoscope inserted into the reinforced endotracheal tube helps to minimize nasal bleeding during nasotracheal intubation.