OBJECTIVE:To determine the association of Arnica montana and blood loss, surgical field bleeding and operative time in endoscopic sinus surgery among adults with chronic rhinosinusitis with nasal polyposis.

METHODS:

Design: Single-blinded Randomized Controlled Trial

Setting: Tertiary government hospital

Participants: Forty-one (41) adults aged 19-76 years old with chronic rhinosinusitis with nasal polyposis and meeting inclusion criteria were randomly divided into two groups, Arnica and control. The former took 5 sublingual Boiron® Arnica montana 30C pellets, 12 hours then 1 hour prior to surgery; the latter did not. Both groups had routine oxymetazoline and lidocaine-epinephrine decongestion. Intraoperative blood loss, surgical field bleeding quality and operative time were assessed by blinded surgeons and anesthesiologists. 

RESULTS: Mean estimated blood loss was 187ml (SD 100.14) for controls versus 72ml (SD 12.59) for the Arnica group; (p < 0.05). Mean operative time was 3.55 hours (SD 1.25) for controls and 3.44 hours (SD 1.57) for the Arnica group; (p=0.9). Surgical field bleeding was graded slight with 75% needing occasional suctioning (grade 2) and 25% needing frequent suctioning (grade 3) in the Arnica group, versus moderate bleeding with more frequent suctioning (grade 4) in 71% and slight bleeding but needing frequent suctioning (grade 3) in 29% of controls.

CONCLUSION: In this randomized clinical trial, Arnica montana was associated with less blood loss and less surgical field bleeding compared to controls, but there was no difference in mean operative times.  Arnica montana may be effective in reducing blood loss and improving surgical field quality during endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.

 

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Hemostasis ; Oxymetazoline

OBJECTIVES: To identify the optimal pharmacological method of preparing patients for nasal endoscopy. METHODS: Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. RESULTS: The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. CONCLUSION: Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.
Anesthetics ; Blood Pressure ; Double-Blind Method* ; Endoscopes ; Endoscopy* ; Healthy Volunteers ; Heart Rate ; Humans ; Lidocaine ; Methods* ; Nasal Decongestants ; Oxymetazoline ; Premedication* ; Prospective Studies* ; Volunteers

OBJECTIVETo investigate the effects of oxymetazoline hydrochloride on ex vivo human nasal cilia movement.

METHODSCiliary beat frequency (CBF) of cultured human nasal epithelial cells was measured by high-speed digital microscopy in HBSS and oxymetazoline hydrochloride of different concentrations in 20 minutes. RESULTS; CBF of cultured nasal epithelial cells in HBSS and 0.25 g/L oxymetazoline hydrochloride did not show significant changes in 20 minutes (F = 0.098, P = 1.00). However, in 0.50 g/L and 1.00 g/L oxymetazoline hydrochloride, CBF increased slightly in 3 -4 minutes and reached the apex, then decreased gradually. At the end of observation, CBF showed no significant difference in 0.50 g/L, (F = 2.94, P = 0.05) but there was a significant lower CBF in 1.00 g/L. In the first 3 minutes, the CBF in 2.00 g/L oxymetazoline hydrochloride was stable, and then slowed gradually. After 16 minutes, there was significant difference. In initial, the highest normalized CBF of each group showed no significant difference. However, the lowest normalized CBF of 1.00 and 2.00 g/L oxymetazoline hydrochloride showed a significant difference with HBSS, 0.25 and 0.50 g/L oxymetazoline hydrochloride.

CONCLUSIONSOxymetazoline had a concentration-dependent inhibitory effect on cultured human nasal CBF from 0.25 to 2.00 g/L. The inhibitory effect increased with the concentration going up. Oxymetazoline hydrochloride of 0.50 g/L might be the optimal choice for clinical application.

Cells, Cultured ; Cilia ; drug effects ; Humans ; Microscopy ; Mucociliary Clearance ; drug effects ; Nasal Mucosa ; drug effects ; Oxymetazoline ; pharmacology ; Sinusitis ; physiopathology ; Tissue Culture Techniques