International forum of allergy & rhinology
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Int Forum Allergy Rhinol · Mar 2019
Randomized Controlled TrialQuality of recovery in patients undergoing endoscopic sinus surgery after general anesthesia: total intravenous anesthesia vs desflurane anesthesia.
For sinus surgery, some centers favor total intravenous anesthesia (TIVA) over inhalation anesthesia. However, whether TIVA affects the patient's perceived quality of recovery remains unclear. This study used the Quality of Recovery-40 questionnaire (QoR-40) to compare patient recovery between surgical patients who received TIVA and those who received desflurane (DES) anesthesia. ⋯ This study shows that the quality of recovery for endoscopic sinus surgery patients was better with TIVA than with desflurane anesthesia. A high LM score was related to poorer recovery quality.
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Int Forum Allergy Rhinol · Jan 2019
Resveratrol and ivacaftor are additive G551D CFTR-channel potentiators: therapeutic implications for cystic fibrosis sinus disease.
Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene result in defective Cl- transport and cause chronic bacterial infections in the upper and lower airways of cystic fibrosis (CF) patients. Ivacaftor is a CFTR potentiator that improves Cl- transport in CF patients with at least 1 copy of the G551D mutation. Resveratrol is also a potent CFTR potentiator that increases determinants of mucociliary transport. The objective of this study is to determine whether resveratrol and ivacaftor improve Cl- secretion in G551D CFTR over either agent alone. ⋯ Additive improvement in G551D CFTR-mediated Cl- secretion suggests that resveratrol could enhance ivacaftor therapy in these patients and improve CF-related rhinosinusitis.
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Int Forum Allergy Rhinol · Jan 2019
International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system.
Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS). ⋯ Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.
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Int Forum Allergy Rhinol · Dec 2018
Case ReportsTechnique for reconstruction of large clival defects through an endoscopic-assisted tunneled retropharyngeal approach.
Reconstruction of the clivus and posterior cranial base defects following endoscopic skull-base surgery can be particularly challenging. Commonly, defects in this region are repaired with pedicled mucoperichondrial flaps from the sinonasal cavity. Complex and large defects often require regional or free flaps, particularly when intranasal flaps have been exhausted. While there are no primary barriers to routing flaps into the clivus or nasopharynx in large open approaches, secondary surgical corridors are necessary during endoscopic cases for routing of free flaps. Routing of free-flap pedicles for endoscopic cranial base reconstruction has been described through secondary surgical corridors created through the maxillary sinus and infratemporal fossa. Here we describe the technique of a more direct pedicle route to the clivus through the retropharyngeal space. ⋯ The retropharyngeal space offers a direct route for tunneling free flaps for the repair of large clival defects during endoscopic skull-base surgery. Several advantages include a less circuitous pedicle route, mucosalization of the fascial flap, avoidance of midfacial degloving, and avoidance of potential disruption of the maxillary sinus.
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Int Forum Allergy Rhinol · Oct 2018
The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015.
Prolonged length of stay (pLOS), disease-related complications, and 30-day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient-level and hospital-level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery. ⋯ Patients undergoing transsphenoidal pituitary surgery at HVCs have shorter hospitalizations, fewer postoperative electrolyte abnormalities, and lower charges; however, socioeconomic factors may influence access to quality care.