الفهرس 
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Anatomy and physiology of the nose and paranasal sinusesOnly 14 pages are availabe for public view
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Abstract
In patients with chronic sinusitis, Functional Endoscopic Sinus Surgery (FESS) is the preferred surgical option as part of treatment after conservative measures have failed. Intraoperative bleeding is the major problem in these endoscopic surgeries. Excessive bleeding impairs operative visibility, prolongs the duration of surgery and anesthesia, and increases the risk of complications. Controlled hypotension is a method in which the arterial blood pressure is decreased in a deliberate but predictable manner to reduce the intraoperative bleeding and enhance the surgical field visibility.
The aim of this study was to study effect of addition of oral Diltiazem and Tranexamic Acid to general anesthesia aimed reduction in blood loss during functional endoscopic sinus surgery (FESS), and study surgeon’s assessment of the surgical field and hemodynamic.
Sixty patients of both sexes, classified as American Society of Anesthesia physical status I and II, aged between 18 and 60 years, and candidates for FESS were randomly allocated three groups. group I: Each patient received a tablet containing 90 mg oral Diltiazem 3 hours before induction of general anesthesia. group II: Each patient received a tablet containing 90 mg oral Diltiazem 3 hours before induction of general anesthesia+ 10 mg/kg Tranexamic Acid slow infusion with saline half an hour before the induction of anesthesia. group III: control group not receiving anything pre-operative.
Vitals were recorded at regular intervals. The following parameters were also recorded: duration of surgical interference (time from the beginning to the end of surgical intervention), duration of anesthesia,
blood loss volume, the quality of surgical field was evaluated by surgeon using the 0-5 point bleeding scale.
In our trial, we found that combination of diltiazem with tranexamic acid was superior and improved the visualization of the surgical field and with lower levels of blood loss. The study groups oral diltiazem & combination of oral diltiazem with tranexamic acid showed a statistically significant lower mean arterial blood pressure than control group.
So we concluded that oral Diltiazem can be used safely for controlled hypotension in functional endoscopic sinus surgeries & combination of diltiazem with tranexamic acid was superior and improved the visualization of the surgical field and also with lower levels of blood loss, for further studies.