Intravital staining with methylene blue in tympanoplasty.

Objective of the study is to investigate usefulness of the methylene blue staining for the operation of tympanoplasty in surgical training process with randomized, controlled trial. Two hospitals were involved: Department of Otolaryngology, Assaf Harofeh Medical Center, and Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center. Tympanoplasty with graft placement was performed by young surgeons on 30 patients (30 ears) with anterior perforations using intraoperative staining of tympanoplasty grafts with methylene blue (Group 1). The same number of patients/ears was operated by the young surgeons without intraoperative staining (Group 2). 76 patients operated without staining by experienced surgeons served as a control group. Results showed tympanic membrane healing (graft take) in 30 (100%) cases in Group 1 and in 26 (86.66%) cases in Group 2. The pure-tone audiogram testing revealed significant improvement of hearing in all successful cases (p < 0.05). No side immediate or postponed effects were detected. We conclude that intravital staining with methylene blue in tympanoplasty simplifies the operation and could assist in better visualization and proper placement of the graft. This technique could be most useful in a training process for resident surgeons.

The use of fibrin sealant as a glue for septoplasty and conchotomy.

OBJECTIVE: The aim of our study was to investigate glue properties of a fibrin sealant in cases of septoplasty and conchotomy. DESIGN: Double-blind prospective randomized study. MATERIALS AND METHODS: A study of 146 patients (80 M, 66 F) who underwent septoplasty and conchotomy was performed in Assaf Harofeh Medical Center Tzrifin, Israel. The patients were divided randomly into two groups: Group I (n = 74) underwent septoplasty with transseptal suturing, and conchotomy with glue as a haemostatic. Group II (n = 72) underwent septoplasty and conchotomy with glue as a haemostatic as well as septal cartilage and mucoperichodrial flaps sealant (no transseptal suturing). The glue was based on a concentrate of human clottable proteins and purified native human thrombin. RESULTS: Our results showed complete healing in both groups without significant differences. One late postoperative nasal bleeding occurred in group I, and none in group II. CONCLUSION: We conclude that the use of second-generation glue in endonasal surgery is well suited to stop nasal bleeding and seal intranasal flaps. Moreover, it might help to avoid transseptal suturing.

Fibrin sealant: alternative to nasal packing in endonasal operations. A prospective randomized study.

OBJECTIVES: Endonasal operations such as septoplasty, rhinoplasty, nasal septal reconstruction and conchotomy, as well as endoscopic sinus surgery, especially when combined with turbinectomy and/or submucous resection of the septum, may produce bleeding and postoperative hematoma requiring postoperative hemostatic measures. Since nasal packing may cause pain, rhinorrhea and inconvenience, a more effective and less uncomfortable hemostatic technique is needed. OBJECTIVES: To compare the hemostatic efficacy of the second-generation surgical sealant (Quixil in Europe and Israel, Crosseal in the USA) to that of nasal packing in endonasal surgery. METHODS: We conducted a prospective randomized trial that included 494 patients (selected from 529 using exclusion and inclusion criteria and completed follow-up) undergoing the above-mentioned endonasal procedures. Patients were assigned to one of three surgical groups: septoplasty + conchotomy + nasal packing or fibrin sealant (Group 1); ESS + nasal packing or fibrin sealant (Group 2); and ESS + septoplasty + conchotomy + nasal packing or fibrin sealant (Group 3). The hemostatic effects were evaluated objectively in the clinic by anterior rhinoscopy and endoscopy and assessed subjectively by the patients at follow-up visits. RESULTS: Postoperative hemorrhage occurred in 22.9-25% of patients with nasal packing vs. 3.12-4.65% in the fibrin sealant groups (late hemorrhage only). Drainage and ventilation of the paranasal sinuses, which are impaired in all cases of packing, remained normal in the fibrin sealant group. There were no allergic reactions to the sealant. CONCLUSIONS: Our results show that fibrin sealant by aerosol spray in endonasal surgery is more effective and convenient than nasal packing. It requires no special treatment, e.g., antibiotics, which are usually used if nasal packing is involved.

Intraoperative ketorolac is an effective substitute for fentanyl in children undergoing outpatient adenotonsillectomy.

BACKGROUND: In this prospective randomized double-blind study, we compared the incidence of emesis and 48-h recovery profiles after a single dose of ketorolac vs fentanyl in dexamethasone-pretreated children undergoing ambulatory adenoidectomy and laser-assisted tonsillectomy (ADLAT). We evaluated the hypothesis that avoiding the use of opioids and replacing them with an equianalgesic dose of ketorolac, a nonsteroidal anti-inflammatory drug, would reduce the incidence of postoperative nausea and vomiting (PONV). METHODS: Fifty-seven ASA I and II children aged 1.710 years who underwent ADLAT were randomized to receive either intravenous ketorolac (1 mg.kg(-1)) or fentanyl (2 microg.kg(-1)) for pain control during a standardized general anaesthetic with propofol infusion. The early (postanaesthesia care unit, day surgical area) and late postoperative courses were compared between the groups. RESULTS: The incidence of PONV was low and equal in both groups. Postoperative pain scores were equal at all stages of followup. Agitation scores in the postanaesthesia care unit were significantly higher in the ketorolac group, but this had no effect on the late variables of behaviour studied. CONCLUSIONS: Ketorolac showed no advantage over fentanyl in reducing the incidence of PONV in children undergoing ADLAT.