Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol 2022 Jan;131(1):59-70
Date
04/13/2021Pubmed ID
33840220DOI
10.1177/00034894211005940Scopus ID
2-s2.0-85104356492 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
OBJECTIVES: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS.
METHODS: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS.
RESULTS: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities.
CONCLUSION: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.
Author List
Feng M, Lao VF, Choby G, Bolton PB, Marino MJ, Weingarten TN, Humphreys IM, Dhillon SK, Choi BY, Fernandez RA, Mehter NS, Chen PGAuthor
Max Feng MD Instructor in the Otolaryngology and Communication Sciences department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Administration, IntravenousAdministration, Topical
Anesthesiology
Antifibrinolytic Agents
Cocaine
Endoscopy
Epinephrine
Health Care Surveys
Humans
Otorhinolaryngologic Surgical Procedures
Oxymetazoline
Paranasal Sinuses
Practice Patterns, Physicians'
Tranexamic Acid
Vasoconstrictor Agents
