The Laryngoscope
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Randomized Controlled Trial Clinical Trial
Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis.
Floseal, a novel hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin, is applied as a high-viscosity gel for hemostasis. This study is a prospective, randomized, controlled clinical trial of Floseal compared with nasal packing in patients with acute anterior epistaxis. ⋯ Floseal hemostatic sealant is a better tolerated, more effective, safe, and easy alternative to nasal packing in patients presenting with acute anterior epistaxis. Future studies may wish to evaluate Floseal's use in posterior epistaxis.
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Randomized Controlled Trial Clinical Trial
Marked hypotension induced by adrenaline contained in local anesthetic.
Local anesthetics containing adrenaline, which often cause cardiovascular side effects, are routinely used in functional endoscopic sinus surgery (FESS) for the main purpose of hemostasis. The controversies concerning hemodynamic effects of adrenaline in local infiltration are widely discussed, but there is no definite conclusion. A prospective, randomized, double-blinded study was carried out to discover the hemodynamic effects after local infiltration of 1:200,000 adrenaline contained in 2% lidocaine under general anesthesia. ⋯ Lidocaine (2%) or saline with adrenaline (1:200,000) does cause temporary hypotension and other hemodynamic changes during general anesthesia, which last no longer than 4 minutes. The causative mechanism is caused by the effect of adrenaline. This is a preliminary study.
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Randomized Controlled Trial Clinical Trial
The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery.
A number of previous studies have tried to assess the effects of hypotension on the surgical field during endoscopic sinus surgery. These studies have been limited by inadequate sample sizes, lack of a control group, and limited data collection. The aim of the present study was to determine whether the routine use of beta-blockers as a pre-medication could improve the operative field in endoscopic sinus surgery. ⋯ Although "optimum" conditions were present in the patients receiving beta-blocker, the authors thought that the grading system was not discriminating enough to demonstrate a significant difference between the groups. The crucial finding in the study was the correlation between heart rate and surgical grade in the entire group. During endoscopic sinus surgery surgery, anesthetic manipulations should be directed at maintaining a low heart rate.
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Randomized Controlled Trial Clinical Trial
Vibration with the canalith repositioning maneuver: a prospective randomized study to determine efficacy.
The objective was to determine whether the inclusion of vibration and additional treatment cycles has an effect on short- and long-term success rates in the treatment of benign paroxysmal positional vertigo with the canalith repositioning maneuver. ⋯ Vibration provided no additional benefit in initial treatment success or in reducing long-term relapse rates when included in the canalith repositioning maneuver. Many patients with benign paroxysmal positional vertigo require more than one canalith repositioning cycle at the time of initial treatment to relieve symptoms, but this does not indicate a higher likelihood for recurrence. No variable predicted a higher rate of recurrence.
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Randomized Controlled Trial Clinical Trial
Hypopharyngeal perforation near-miss during transesophageal echocardiography.
The traditional blind passage of a transesophageal echocardiography probe transorally through the hypopharynx is considered safe. Yet, severe hypopharyngeal complications during transesophageal echocardiography at several institutions led the authors to investigate whether traditional probe passage results in a greater incidence of hypopharyngeal injuries when compared with probe passage under direct visualization. ⋯ Optically guided trans-esophageal echocardiography results in significantly fewer hypopharyngeal injuries and fewer contacts than traditional, blind transesophageal echocardiography. The optically guided technique may result in decreased frequency of potentially significant complications and therefore in improved patient safety.