title: Meta-analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery.
abstract: BACKGROUND
  Functional endoscopic sinus surgery (FESS) has been used as the standard of treatment for sinonasal disease in which medical therapy fails to ameliorate the disease. Intraoperative hemostasis is a crucial factor in FESS. Currently, ideal techniques for creating intraoperative hemostasis have yet to be clarified and standardized. We sought to better understand what variables can affect intraoperative blood loss and therefore improve surgical field outcomes.
  
  
  METHODS
  A literature search was conducted using PubMed, OVID, MD Consult, and Micromedex with keywords including: FESS, intraoperative blood loss, hemorrhage, and vasoconstriction. The articles were then evaluated with regard to blood loss, surgical grade, and operative time. Eleven articles were cross-referenced to determine the most statistically significant techniques in 3 main categories: general anesthetics, preoperative steroids, and use of epinephrine.
  
  
  RESULTS
  Analysis of the articles indicate that total intravenous anesthesia (TIVA) is statistically more beneficial than balanced anesthesia (BA), providing an average difference in blood loss of 75.3057 mL; the use of preoperative steroids is statistically more beneficial than placebo, with an improved difference in blood loss of 28 mL; and a trend toward hemostasis with the use of local anesthetics at a concentration of 1:200,000.
  
  
  CONCLUSIONS
  Meta-analysis of 1148 patients concludes that hemostasis during FESS is best conducted using TIVA, preoperative steroids, and topical local anesthetic at a 1:200,000 concentration.
authors.affiliation: School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79416, USA. Akhil.khosla@ttuhsc.edu
authors.forename: Akhil J
authors.initials: AJ
authors.lastname: Khosla
authors.forename: Francisco G
authors.initials: FG
authors.lastname: Pernas
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Maeso
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000379:methods; D010256:Paranasal Sinuses / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D013256:Steroids; D014662:Vasoconstrictor Agents; D004837:Epinephrine