Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery

Abstract

Objective: To evaluate the use of terlipressin for intraoperative bleeding reduction in functional endoscopic sinus surgery (FESS). Methods: This prospective, randomized, single-center, single-blinded cohort study included 74 cases of FESS performed under general anesthesia (GA). The patients were randomized into two groups: WT (without terlipressin, n = 39) and T (with 200 μg terlipressin, n = 35). Bleeding intensity (BI) was assessed using a 6-point scale. Heart rate (HR), mean blood pressure (MBP), perfusion index (PI), and BI were recorded at 10, 30, and 60 min after surgery. A BI score ≥2 qualified as significant. Results: The T group had significantly higher MBP compared with the WT group, but HR values did not differ significantly. PI and BI scores were significantly reduced in the T group compared with the WT group. The risk of significant bleeding in the treatment group was 35.5 times lower (odds ratio [OR], 0.028; 95% confidence interval [CI], 0.006–0.138) at 30 min and 7.1 times lower (OR, 0.140; 95% CI, 0.049–0.402) at 60 min. The prognostic model for significant bleeding at 60 min showed that only terlipressin played a significant role in bleeding control (p < 0.05). The model predicted a 13.9-fold decrease in significant bleeding risk in the T group. Conclusion: Low doses (200 μg) of terlipressin reduced intraoperative bleeding without decreasing blood pressure during FESS under GA. Level of Evidence: 2 Laryngoscope, 133:3313–3318, 2023.