Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery

Max Feng; Veronica F. Lao; Garret Choby; Patrick B. Bolton; Michael J. Marino; Toby N. Weingarten; Ian M. Humphreys; Sabrina K. Dhillon; Byeong Y. Choi; Roman A. Fernandez; Najma S. Mehter; Philip G. Chen

doi:10.1177/00034894211005940

Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery

Max Feng, Veronica F. Lao, Garret Choby, Patrick B. Bolton, Michael J. Marino, Toby N. Weingarten, Ian M. Humphreys, Sabrina K. Dhillon, Byeong Y. Choi, Roman A. Fernandez, Najma S. Mehter, Philip G. Chen

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Objectives: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. Methods: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. Results: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Conclusion: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.

Original language	English (US)
Pages (from-to)	59-70
Number of pages	12
Journal	Annals of Otology, Rhinology and Laryngology
Volume	131
Issue number	1
DOIs	https://doi.org/10.1177/00034894211005940
State	Published - Jan 2022

Keywords

education
endoscopic sinus surgery
intravenous tranexamic acid
surgical field visibility
topical cocaine
topical epinephrine
topical oxymetazoline

ASJC Scopus subject areas

Otorhinolaryngology

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10.1177/00034894211005940

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Feng, M., Lao, V. F., Choby, G., Bolton, P. B., Marino, M. J., Weingarten, T. N., Humphreys, I. M., Dhillon, S. K., Choi, B. Y., Fernandez, R. A., Mehter, N. S., & Chen, P. G. (2022). Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery. Annals of Otology, Rhinology and Laryngology, 131(1), 59-70. https://doi.org/10.1177/00034894211005940

Feng, M, Lao, VF, Choby, G, Bolton, PB, Marino, MJ, Weingarten, TN, Humphreys, IM, Dhillon, SK, Choi, BY, Fernandez, RA, Mehter, NS & Chen, PG 2022, 'Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery', Annals of Otology, Rhinology and Laryngology, vol. 131, no. 1, pp. 59-70. https://doi.org/10.1177/00034894211005940

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title = "Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery",

abstract = "Objectives: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. Methods: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. Results: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Conclusion: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.",

keywords = "education, endoscopic sinus surgery, intravenous tranexamic acid, surgical field visibility, topical cocaine, topical epinephrine, topical oxymetazoline",

author = "Max Feng and Lao, {Veronica F.} and Garret Choby and Bolton, {Patrick B.} and Marino, {Michael J.} and Weingarten, {Toby N.} and Humphreys, {Ian M.} and Dhillon, {Sabrina K.} and Choi, {Byeong Y.} and Fernandez, {Roman A.} and Mehter, {Najma S.} and Chen, {Philip G.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2021.",

year = "2022",

month = jan,

doi = "10.1177/00034894211005940",

language = "English (US)",

volume = "131",

pages = "59--70",

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AU - Feng, Max

AU - Lao, Veronica F.

AU - Choby, Garret

AU - Bolton, Patrick B.

AU - Marino, Michael J.

AU - Weingarten, Toby N.

AU - Humphreys, Ian M.

AU - Dhillon, Sabrina K.

AU - Choi, Byeong Y.

AU - Fernandez, Roman A.

AU - Mehter, Najma S.

AU - Chen, Philip G.

N1 - Publisher Copyright: © The Author(s) 2021.

PY - 2022/1

Y1 - 2022/1

N2 - Objectives: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. Methods: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. Results: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Conclusion: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.

AB - Objectives: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. Methods: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. Results: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Conclusion: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.

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KW - surgical field visibility

KW - topical cocaine

KW - topical epinephrine

KW - topical oxymetazoline

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Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery

Abstract

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