Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis

Introduction: Intraoperative hemostasis is crucial for adequate anatomical visualization during endoscopic sinus surgery (ESS) and has been identified as gold-standard treatment for medically refractory chronic rhinosinusitis (CRS). Effective surgery is termed upon adequate identification of anatomi...

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Main Author:	Nagarajah, Darshini
Format:	Thesis
Language:	English
Published:	2020
Subjects:	RF Otorhinolaryngology
Online Access:	http://eprints.usm.my/57290/1/DR%20DARSHINI%20NAGARAJAH-24%20pages.pdf
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spelling	my-usm-ep.572902023-11-20T08:16:20Z Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis 2020 Nagarajah, Darshini RF Otorhinolaryngology Introduction: Intraoperative hemostasis is crucial for adequate anatomical visualization during endoscopic sinus surgery (ESS) and has been identified as gold-standard treatment for medically refractory chronic rhinosinusitis (CRS). Effective surgery is termed upon adequate identification of anatomic structures, good surgical visualization and controlled bleeding throughout the surgery. Nasal saline irrigation is a novel technique to reduced intra-operative bleeding during endoscopic sinus surgery. Objective: The aim of this research is to assess the suitable and optimum temperature for nasal saline irrigation during endoscopic sinus surgery with regards to bleeding control and quality of surgery site during endoscopic sinus surgery(ESS). Methods: Three authors independently conducted an electronic search via (PubMed, SCOPUS, Google Scholar) and (Cochrane) from their origination to September 2018. The included studies compared nasal saline irrigation (hot saline /warm saline irrigation (HSI/WSI) versus room temperature/normal saline irrigation (RTSI/NSI) during ESS. The outcomes of interest were bleeding score(BS), mean arterial pressure(MAP), duration of the surgery(DS), blood loss (BL), and the surgeon satisfaction score (SS). Results: Based on three studies with a total of 212 patients providing the data, we found that WSI/ HSI produced a better outcome compared to the RTSI/NSI group in the surgical field quality (Mean Difference (MD)= -0.51, 95% CI [-0.84,-0.18], P<.003, I2=72%), 3 studies consisting 237 patients ;moderate certainty. There was no significant difference between the two comparison group in regard to mean arterial pressure ( Mean Difference(MD)= -0.60, 95% CI [-2.17, 0.97], P=0.45, I2=0% , 3 studies with 237 patients; moderate certainty. The surgeons’ satisfaction about the significant reduction in bleeding during the operation showed that there was significant decrease in bleeding in WSI/HSI compared to RTSI/NSI in two studies (Risk ratio = 0.18, 95% CI [ 0.09, 0.33] P<0.001, I2= 0% , 2 studies with 175 patients ; moderate certainty). The volume of blood loss was also significantly higher in groups under RTSI/NSI than HSI/WSI in all the studies reviewed (Mean Difference (MD)=56.4, 95% CI[-57.30, -55.51], P<0.001,I2=0%; moderate certainty). The duration of surgery showed significant increase in RTSI/NSI group than HSI/WSI group in all the studies (Mean Difference (MD)= -9.02, 95% CI [-11.76, -6,28], P<0.001, I2=0% , 3 studies with 237 patients ; moderate certainty). Conclusion: The evidence from this review suggests that WSI/HSI group are statistically better compared to RTSI/NSI group. Also, no beneficial or detrimental effect of surgeons’ satisfaction score could be determined based on existing evidence. However, since very small number of studies were recruited, further trials are needed to establish the results of this study. 2020 Thesis http://eprints.usm.my/57290/ http://eprints.usm.my/57290/1/DR%20DARSHINI%20NAGARAJAH-24%20pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RF Otorhinolaryngology
spellingShingle	RF Otorhinolaryngology Nagarajah, Darshini Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
description	Introduction: Intraoperative hemostasis is crucial for adequate anatomical visualization during endoscopic sinus surgery (ESS) and has been identified as gold-standard treatment for medically refractory chronic rhinosinusitis (CRS). Effective surgery is termed upon adequate identification of anatomic structures, good surgical visualization and controlled bleeding throughout the surgery. Nasal saline irrigation is a novel technique to reduced intra-operative bleeding during endoscopic sinus surgery. Objective: The aim of this research is to assess the suitable and optimum temperature for nasal saline irrigation during endoscopic sinus surgery with regards to bleeding control and quality of surgery site during endoscopic sinus surgery(ESS). Methods: Three authors independently conducted an electronic search via (PubMed, SCOPUS, Google Scholar) and (Cochrane) from their origination to September 2018. The included studies compared nasal saline irrigation (hot saline /warm saline irrigation (HSI/WSI) versus room temperature/normal saline irrigation (RTSI/NSI) during ESS. The outcomes of interest were bleeding score(BS), mean arterial pressure(MAP), duration of the surgery(DS), blood loss (BL), and the surgeon satisfaction score (SS). Results: Based on three studies with a total of 212 patients providing the data, we found that WSI/ HSI produced a better outcome compared to the RTSI/NSI group in the surgical field quality (Mean Difference (MD)= -0.51, 95% CI [-0.84,-0.18], P<.003, I2=72%), 3 studies consisting 237 patients ;moderate certainty. There was no significant difference between the two comparison group in regard to mean arterial pressure ( Mean Difference(MD)= -0.60, 95% CI [-2.17, 0.97], P=0.45, I2=0% , 3 studies with 237 patients; moderate certainty. The surgeons’ satisfaction about the significant reduction in bleeding during the operation showed that there was significant decrease in bleeding in WSI/HSI compared to RTSI/NSI in two studies (Risk ratio = 0.18, 95% CI [ 0.09, 0.33] P<0.001, I2= 0% , 2 studies with 175 patients ; moderate certainty). The volume of blood loss was also significantly higher in groups under RTSI/NSI than HSI/WSI in all the studies reviewed (Mean Difference (MD)=56.4, 95% CI[-57.30, -55.51], P<0.001,I2=0%; moderate certainty). The duration of surgery showed significant increase in RTSI/NSI group than HSI/WSI group in all the studies (Mean Difference (MD)= -9.02, 95% CI [-11.76, -6,28], P<0.001, I2=0% , 3 studies with 237 patients ; moderate certainty). Conclusion: The evidence from this review suggests that WSI/HSI group are statistically better compared to RTSI/NSI group. Also, no beneficial or detrimental effect of surgeons’ satisfaction score could be determined based on existing evidence. However, since very small number of studies were recruited, further trials are needed to establish the results of this study.
format	Thesis
qualification_level	Master's degree
author	Nagarajah, Darshini
author_facet	Nagarajah, Darshini
author_sort	Nagarajah, Darshini
title	Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
title_short	Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
title_full	Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
title_fullStr	Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
title_full_unstemmed	Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
title_sort	hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2020
url	http://eprints.usm.my/57290/1/DR%20DARSHINI%20NAGARAJAH-24%20pages.pdf
_version_	1794024021377941504

Hemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis

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