Anesthetic recovery outcomes after 2 methods of nasal mucosal preparation for endoscopic sinus surgery.

Autor: Meas S; Nurse Anesthesia Program, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, United States of America; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America., O'Brien EK; Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States of America., Stokken JK; Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States of America., Choby GW; Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States of America., Pinheiro-Neto CD; Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States of America., Schroeder DR; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America., Sprung J; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America., Weingarten TN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: weingarten.toby@mayo.edu.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2024 Jul 23; Vol. 45 (6), pp. 104414. Date of Electronic Publication: 2024 Jul 23.
DOI: 10.1016/j.amjoto.2024.104414
Abstrakt: Purpose: Our institution uses two approaches for nasal mucosal preparation during endoscopic sinus surgery (ESS) to improve surgical field visualization: topical epinephrine (TE) versus topical cocaine with injection of lidocaine containing epinephrine (TCLE). We aimed to compare anesthetic outcomes after ESS using these techniques.
Methods and Materials: We retrospectively identified adult patients at our institution who underwent ESS from May 2018 through January 2023 under general anesthesia with propofol and remifentanil infusions. Postoperative anesthetic outcomes, including pain and recovery time, were compared between patients who had mucosal preparation with TE versus TCLE using inverse probability of treatment weighting (IPTW) to adjust for potential confounders.
Results: Among 1449 patients who underwent ESS, 585 had TE, and 864 had TCLE. Compared with TE, during anesthetic recovery, the TCLE group had fewer episodes of severe pain (numeric pain score ≥ 7) (IPTW-adjusted odds ratio, 0.65; 95 % CI, 0.49-0.85; P = .002), less opioid analgesic administration (IPTW-adjusted odds ratio, 0.55; 95 % CI, 0.44-0.69; P < .001), and shorter recovery room stay (IPTW-adjusted ratio of the geometric mean, 0.90; 95 % CI, 0.85-0.96; P = .002). Postoperative nausea and vomiting and postoperative sedation were similar between groups.
Conclusions: Patients who received preparation of the nasal mucosa with TCLE, compared with TE, were less likely to report severe pain or receive an opioid analgesic in the postanesthesia recovery room and had faster anesthetic recovery. This observation from our large clinical practice indicates that use topical and local anesthetic during endoscopic sinus surgery may have benefit for ambulatory ESS patients.
Competing Interests: Declaration of competing interest T.N.W. reports financial support from Medtronic Corporation, Merck, Enalare Therapeutics Inc., Takeda Pharmaceutical Company Limited, and Trevena Inc. J.K.S. reports financial support from Acclarent, Inc.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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