Nasal Desmopressin Versus Topical Epinephrine in Endonasal Dacryocystorhinostomy

Zagazig University52 enrolled

Overview

Dacryocystorhinostomy aims to create a channel between the lacrimal sac and nasal mucosa to relieve nasolacrimal duct occlusion. General anesthesia is still preferred by many surgeons to secure the airway and control blood pressure.

Bleeding even minor can obscure the surgical field. This can extend the operative time \& increase the failure rate. The hemostatic effect of desmopressin on the quality of the surgical field was investigated in patients undergoing endoscopic sinus surgery and revealed that desmopressin could reduce intraoperative bleeding.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Anesthesia

Interventions

Desmopressin Acetate Nasal, 10 μg/0.1 ml per sprayDRUG

The patient will receive two puffs of desmopressin acetate 10 µg/puff in the side of the nasal cavity ipsilateral to the obstructed lacrimal duct (20 μg totally) 60 minutes before surgery.

Epinephrine topical 1:100,000 Nasal PacksDRUG

The patient will receive topical 1:100,000 epinephrine in the side of the nasal cavity ipsilateral to the obstructed lacrimal gland via 3 soaked packs placed in the middle meatus for 5 minutes immediately before the start of surgery.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age: 18-45 years old. * Physical status: ASA I \& II. * Type of operations: elective endonasal dacryocystorhinostomy under general anesthesia. * Written informed consent from the patient. Exclusion Criteria: * Patient refusal. * Known hypersensitivity to study drugs. * Nasal pathology as active infection or an anatomical abnormality. * Hyponatremia "serum Na+ less than 135". * Coagulation disorders. * Renal or cardiovascular disorders.

Locations (1)

Zagazig university hospital

Zagazig, Al-Sharkia, Egypt

Outcomes

Primary Outcomes

Intraoperative blood loss

Estimation of intraoperative blood loss will be done at 30th minutes of surgery. by calculating the loss of blood and irrigation saline in 50 mL-graded suction canisters.

Time frame: Measurement will be done at the 30th minutes of the start of surgery.

Intraoperative blood loss

Estimation of intraoperative blood loss will be done at 60th minutes of surgery. by calculating the loss of blood and irrigation saline in 50 mL-graded suction canisters.

Time frame: Measurement will be done at 60th minutes of the start of surgery.

Secondary Outcomes

The Surgical field clarity

The quality of surgical field based on BOEZAART grading system(0 no bleeding; 1 slight bleeding: no suctioning is needed; 2 slight bleeding: occasional suctioning needed;, 3 sight bleeding: frequent suctioning required, bleeding threatens surgical field a few seconds after suction is removed; 4 moderate bleeding: frequent suctioning required and bleeding threatens surgical field directly after suction is removed; 5 severe bleeding: constant suctioning required)

Time frame: at the end of surgery

Change in heart rate (HR) in beat per minute

Change in heart rate (HR) from baseline.

Time frame: will be recorded at 2 minutes, 5 minutes, 10 minutes, 30 minutes and 60 minutes after topical epinephrine packs insertion.

Change mean arterial blood pressure (MAP) in mmHg

Change mean arterial blood pressure (MAP) from baseline.

Time frame: will be recorded at 2 minutes, 5 minutes, 10 minutes, 30 minutes and 60 minutes after topical epinephrine packs insertion.

Change oxygen saturation (SPO2)

Data from ClinicalTrials.gov

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