Nasal Desmopressin Versus Oral Bisoprolol for Controlling Bleeding During Endoscopic Sinus Surgery
Condition: Bleeding
MeSH terms: Hemorrhage
Study type: Interventional
Phase: Phase 2

Summary: 
      Functional endoscopic sinus surgery (FESS) is well established for treatment of chronic
      rhinosinusitis and nasal polyps. Masking of the surgical field can lead to severe
      complication as tissue injury, increase post-operative adhesions and scarring and even severe
      orbital and brain injury In the current study we will investigate the effect of nasal
      desmopressin versus oral bisoprolol for controlling bleeding and improving surgical field
      clarity during functional endoscopic sinus surgery
    

Detailed description: 
      Functional endoscopic sinus surgery (FESS) is well established for treatment of chronic
      rhinosinusitis and nasal polyps.

      The nasal mucosa at the site of surgery is very sensitive to sympathetic stimulation which
      Cause intraoperative hypertension and tachycardia. It is also highly vascular and can bleed
      easily, so Compromise the visual clarity of the surgical field. Masking of the surgical field
      can lead to severe complication as tissue injury, increase post-operative adhesions and
      scarring and even severe orbital and brain injury. Multiple techniques have been discussed to
      improve the surgical field in endoscopic sinus surgery, including the use of bipolar
      diathermy, topical vasoconstrictors, and induced hypotension, However none of them has
      provided optimal surgical condition.

      Desmopressin (1 deamino 8 D argininevasopressin) is a synthetic analog of the antidiuretic
      hormone L arginine vasopressin. It was used in mild to moderate hemophilia, von Willebrand's
      disease, and other acquired platelet deficiencies to increases plasma concentrations of
      tissue plasminogen activator and endothelial factor VIII. Intravenous use was proved to
      decrease intraoperative bleeding during spine surgery, facial plastic surgeries,
      septo-rhinoplasty and FESS. Intranasal spray used effectively to reduce bleeding and improves
      the surgical field during FESS.

      The short acting β-adrenergic receptor antagonist such as labetalol, metoprolol and esmolol
      have been successfully used for lowering blood pressure, decreasing bleeding and improving
      surgical field.

      Bisoprolol, has the advantage of longer acting. Bisoprolol has a higher degree of
      β1-selectivity compared to other β1-selective beta blockers such as atenolol, metoprolol, and
      betaxolol. It was approved for medical use in the United States in 1992. Bisoprolol inhibits
      renin secretion by about 65% and tachycardia by about 30%.

      In the current study we will investigate the effect of nasal desmopressin versus oral
      bisoprolol for controlling bleeding and improving surgical field clarity during functional
      endoscopic sinus surgery.
    

Intervention name(s): nasal Desmopressin
Intervention type(s): Drug
Intervention description(s): compare the effect of nasal desmopressin versus oral bisoprolol for controlling bleeding and improving surgical field clarity during functional endoscopic sinus surgery.
Other intervention name(s): oral Bisoprolol
Intervention MeSH terms: Bisoprolol; Deamino Arginine Vasopressin
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: comparing Preoperative Nasal Desmopressin versus Oral Bisoprolol for Controlling Bleeding and Improving Surgical Field during Unilateral Functional Endoscopic Sinus Surgery
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Desmopressin ,bisoprolol,Sinus Surgery