Use of α2-Adrenergic Agonists to Improve Surgical Field Visibility in Endoscopy Sinus Surgery: A Systematic Review of Randomised Controlled Trials.

PURPOSE: We assessed the evidence for the use of α2-adrenergic agonists (A2AAs) in bleeding control and field quality in endoscopic sinus surgery. METHODS: We systematically reviewed randomized clinical trials (RCTs) assessing A2AAs in endoscopic sinus surgery. Abstracts were reviewed by 2 investigators for eligibility, and selected articles were fully reviewed. Data on study design, population, A2AA drug and control groups, bleeding and surgical field quality outcomes, and adverse effects were extracted and synthesized. FINDINGS: A total of 13 RCTs that included 896 individuals (7 double-blind trials, 5 single-blind trials, and 1 open-label trial) were selected that assessed the efficacy of clonidine (6 RCTs, 407 patients), dexmedetomidine (6 RCT, 423 patients), or both (1 RCT, 66 patients). Clonidine was compared with placebo (3 RCTs), midazolam (1 RCT), and remifentanil (2 RCTs). Dexmedetomidine was compared with esmolol (2 RCTs), remifentanil (2 RCTs), nitroglycerin and esmolol (1 RCT), and magnesium sulfate (1 RCT). Clonidine and dexmedetomidine were compared in 1 RCT. Clonidine reduced the proportion of individuals with an impaired surgical field by 23% vs placebo (number needed to treat = 4). Clonidine was better than midazolam and remifentanil in 2 trials, and dexmedetomidine was better than magnesium sulfate and esmolol in 2 trials but was not superior to esmolol, remifentanil, or nitroglycerin in 4 trials. Dexmedetomidine produced significantly better differences in bleeding outcomes versus clonidine. Adverse events were infrequent and mainly caused by hypotension or bradycardia. IMPLICATIONS: RCTs consistently report that A2AAs reduce bleeding and improve surgical field quality during endoscopic sinus surgery. Adverse event reporting was often omitted in RCTs. Well-designed RCTs with appropriate sample sizes are desirable to identify the best A2AAs and confirm their potential effects on clinical outcomes.

Síndrome del seno silente: abordaje endoscópico y reconstrucción orbitaria en un solo tiempo / Single surgical step for endoscopic surgery and orbital reconstruction of a silent sinus syndrome

El síndrome del seno silente (SSS) es una entidad infrecuente caracterizada por enoftalmos, y provocada por la atelectasia homolateral del seno maxilar. El diagnóstico es clínico con confirmación radiológica. El tratamiento tiene dos objetivos, regularizar la aireación del seno maxilar mediante la normalización del drenaje desde la cavidad nasal y restaurar la arquitectura orbitaria. Presentamos un caso de SSS tratado en nuestro hospital en un solo tiempo quirúrgico (AU)

Silent sinus syndrome (SSS) is an uncommon disease characterised by enophthalmos, caused by ipsilateral maxillary sinus atelectasis. The diagnosis is clinical with radiological confirmation. The treatment has two objectives: to regulate the aeration of the maxillary sinus through achieving normal nasal cavity drainage and to restore the orbital architecture. A case of SSS treated in our hospital in a single surgical intervention is reported (AU)

Amigdalectomía mediante electrodisección y mascarilla laríngea / Electrodissection tonsillectomy with laryngeal mask

Introducción: La electrodisección con bisturí de Colorado® se utiliza desde hace 30 años como alternativa a la disección fría. Alexander fue el primero en publicar resultados de la mascarilla laríngea en otorrinolaringología y cirugía maxilofacial. Posteriormente se ha introducido como alternativa anestésica habitual en nuestra especialidad. Objetivo: El objetivo de este estudio es comprobar los resultados de la aplicación combinada de estas 2 técnicas en amigdalectomías, ya por separado han demostrado sus beneficios. Métodos: Presentamos un estudio observacional prospectivo de 107 amigdalectomías con o sin adenoidectomía pediátricas. Se analizan una serie de variables durante todo el proceso como el dolor (escala de Brodman), la analgesia, el sangrado, el edema de úvula, los días hasta normalizar la dieta, la habituación a la vida normal y los tiempos quirúrgico, anestésico y total de quirófano. Resultados: La técnica de electrodisección con bisturí de Colorado® minimiza el sangrado intraoperatorio y la necesidad de hemostasia. El edema de úvula y el dolor local aumenta comparado con la disección en frío. No hay variaciones clínicas en cuanto a los días que tarda el paciente en recuperar su vida normal. La combinación de la anestesia con mascarilla laríngea y la electrodisección con Colorado® reduce el tiempo quirúrgico, anestésico y total de quirófano. Conclusiones: La combinación de ambas técnicas es un método seguro, rápido y eficaz que se beneficia de las ventajas de ambas sin suponer un aumento de los riesgos quirúrgicos ni anestésicos (AU)

Introduction: The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective: The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods: We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results: The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions: The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks (AU)

Electrodissection tonsillectomy with laryngeal mask.

INTRODUCTION: The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks.

Single surgical step for endoscopic surgery and orbital reconstruction of a silent sinus syndrome.

Silent sinus syndrome (SSS) is an uncommon disease characterised by enophthalmos, caused by ipsilateral maxillary sinus atelectasis. The diagnosis is clinical with radiological confirmation. The treatment has two objectives: to regulate the aeration of the maxillary sinus through achieving normal nasal cavity drainage and to restore the orbital architecture. A case of SSS treated in our hospital in a single surgical intervention is reported.

[Tympanostomy tube placement in children with secretory otitis media: analysis of effects and complications]. / Colocación de tubos de ventilación transtimpánicos en niños con otitis seromucosa: análisis de resultados y complicaciones.

INTRODUCTION AND OBJECTIVES: Tympanostomy tube emplacement is a common surgical procedure in paediatric otolaryngological surgery. This surgery has complications that sometimes depend on the disease and at other times on the treatment. The objective of this study is to know the results obtained with tympanostomy tube emplacement and its complications. MATERIAL AND METHODS: Retrospective study of all the children operated on for tympanostomy tube emplacement over a period of 18 months and with follow-up for at least seven years; this amounted to 143 ears operated on for the first time. The study variables were age, gender, initial appearance of the ear, inner ear contents, type of grommet inserted, duration of grommet and the lack of any hospital monitoring needed after extrusion. RESULTS: One complication or another arose in 46% of the ears. The Donaldson type of grommet with a diameter of 1.27 mm is the one that produced most complications. There were more complications in ears that were worse in the otoscopic examination regardless of the grommet inserted. CONCLUSIONS: The high prevalence of complications and after-effects after grommet emplacement needs long-term follow-up in patients. The results obtained suggest the use of grommets with a smaller internal diameter.

Colocación de tubos de ventilación transtimpánicos en niños con otitis seromucosa: análisis de resultados y complicaciones / Tympanostomy tube emplacement in children with secretory otitis media: analysis of effects and complications

Introducción y objetivos: La colocación de tubos de ventilación transtimpánicos (TVT) es una de las cirugías más habituales de la otorrinolaringología pediátrica. Esta cirugía no está exenta de complicaciones que, a veces, dependen de la propia enfermedad y, otras, de su tratamiento. El objetivo de este estudio es conocer los resultados que hemos obtenido con la colocación de tubos de ventilación transtimpánicos y sus complicaciones. Material y métodos: Estudio retrospectivo de todos los niños intervenidos con colocación de TVT, en un período de 18 meses, y un seguimiento mínimo de 7 años, 143 oídos intervenidos por primera vez. Las variables objeto del estudio son: edad, sexo, aspecto inicial del oído, contenido del oído, tipo de TVT colocado, duración del TVT, complicaciones aparecidas y no necesitar controles hospitalarios tras extrusión del TVT. Resultados: El 46 % de los casos presentaron algún tipo de complicación. El TVT que más complicaciones nos ha producido es el tipo Donaldson de 1,27 mm de diámetro interno. Aparecen más complicaciones en los oídos que estaban peor en la otoscopia independientemente del TVT colocado. Conclusiones: La alta incidencia de complicaciones y/o secuelas tras la colocación de TVT hace necesario el seguimiento de los pacientes durante un largo período. Los resultados obtenidos orientan a utilizar TVT de diámetro interno más pequeño (AU)

Introduction and objectives: Tympanostomy tube emplacement is a common surgical procedure in paediatric otolaryngological surgery. This surgery has complications that sometimes depend on the disease and at other times on the treatment. The objective of this study is to know the results obtained with tympanostomy tube emplacement and its complications. Material and methods: Retrospective study of all the children operated on for tympanostomy tube emplacement over a period of 18 months and with follow-up for at least seven years; this amounted to 143 ears operated on for the first time. The study variables were age, gender, initial appearance of the ear, inner ear contents, type of grommet inserted, duration of grommet and the lack of any hospital monitoring needed after extrusion. Results: One complication or another arose in 46 % of the ears. The Donaldson type of grommet with a diameter of 1.27 mm is the one that produced most complications. There were more complications in ears that were worse in the otoscopic examination regardless of the grommet inserted. Conclusions: The high prevalence of complications and after-effects after grommet emplacement needs long-term follow-up in patients. The results obtained suggest the use of grommets with a smaller internal diameter(AU)