Warm intranasal saline irrigation reduces intraoperative blood loss during functional endoscopic sinus surgery: a propensity score-matched cohort study.

چکیده اصلی

BACKGROUND: To evaluate whether warm intranasal saline irrigation (38-40 °C) during functional endoscopic sinus surgery (FESS) is associated with reduced intraoperative bleeding compared with standard cold irrigation (18-21 °C). METHODS: We performed a single-centre retrospective cohort study of consecutive FESS procedures under inhalational general anaesthesia (January 2017-December 2022). After exclusions, 1,990 cases were eligible. One-to-one propensity score matching (age, sex, ASA class, and type of inhaled anaesthetic) yielded 409 warm and 409 cold cases. Primary outcomes were estimated blood loss and blood loss >50 mL. Secondary outcomes included anaesthesia duration, intraoperative medication requirements, and lowest recorded temperature. Multivariable logistic regression adjusted for BIS monitoring utilisation, intravenous fluid rate, and intraoperative antihypertensive medication use. RESULTS: Median blood loss was 50 mL (IQR 50-50) with warm irrigation versus 50 mL (IQR 50-100) with cold irrigation (p = 0.001). Blood loss >50 mL occurred in 18.6% versus 32.0%, respectively (p < 0.001). Warm irrigation remained independently associated with lower odds of blood loss >50 mL (adjusted OR 0.45, 95% CI 0.31-0.66; p < 0.001). BIS monitoring was also protective (adjusted OR 0.57, 95% CI 0.37-0.87; p = 0.009). Warm irrigation was associated with shorter anaesthesia duration (median 2.82 vs 3.38 h; p < 0.001) and a slightly higher nadir temperature (35.6 vs 35.5 °C; p = 0.007). CONCLUSIONS: Warm intranasal saline irrigation at 38-40 °C was associated with fewer clinically significant bleeding events during routine FESS and may represent a simple, low-cost adjunct to perioperative haemostatic management.

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