title: The effect of anterior palatine blocks on bleeding in hereditary hemorrhagic telangiectasia nasal surgery.
abstract: OBJECTIVE
  When combined with local sphenopalatine (SP) injection and moderate hypotension, transoral or transcutaneous local injection of the anterior palatine (AP) vessels reduces intraoperative bleeding in hereditary hemorrhagic telangiectasia (HHT) patients undergoing nasal surgery.
  
  
  METHODS
  Retrospective chart review of 55 consecutive HHT patients undergoing a bevacizumab injection for recalcitrant epistaxis. Nineteen patients received local injections to only the SP vasculature, and 36 patients received AP and SP injections.
  
  
  METHODS
  Main outcome variable was estimated blood loss during nasal surgery. Independent variables included sex, age, epistaxis severity score, surgical techniques (including laser), and blood pressure parameters (baseline, preinduction, and postintubation).
  
  
  RESULTS
  The mean blood loss in HHT patients receiving SP injections alone was 111 mL, whereas it was 22 mL for those receiving both AP + SP injections. This difference between groups approached statistical significance (P = .075). Blood pressure parameters were similar in both groups with no appreciable difference between intraoperative systolic and mean arterial blood pressure.
  
  
  CONCLUSIONS
  The addition of either sublabial or transcutaneous AP injection to the standard SP block markedly reduces blood loss in HHT epistaxis nasal surgery.
authors.affiliation: Department of Surgery, University of California, San Diego, San Diego, California, U.S.A.
authors.forename: Carly C
authors.initials: CC
authors.lastname: Guthrie
authors.forename: Tom T
authors.initials: TT
authors.lastname: Karnezis
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Orosco
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bishop
authors.forename: Terence M
authors.initials: TM
authors.lastname: Davidson
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004844:Epistaxis / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures; D010159:Palate; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: Hereditary hemorrhagic telangiectasia; bevacizumab; epistaxis; sphenopalatine