J Rhinol.  2024 Mar;31(1):8-16. 10.18787/jr.2024.00007.

Does Desmopressin Reduce Intraoperative Bleeding in Patients Who Undergo Nasal Surgery? A Systematic Review and Meta-Analysis

• Kim SH
• Bae AY
• Kim DH
• Hwang SH

• KMID: 2554085
• DOI: http://doi.org/10.18787/jr.2024.00007

Abstract

Background and Objectives
This study aimed to determine the efficacy of prophylactic desmopressin administered via the intranasal or intravenous route in reducing intraoperative bleeding during nasal surgery. We conducted a meta-analysis of the relevant literature to investigate the role of preoperative desmopressin in minimizing bleeding complications associated with nasal surgery.
Methods
We screened the relevant literature published before February 2023. Nine articles that compared the perioperative use of desmopressin (treatment) with a placebo or no treatment (control) were included. The analyzed outcomes were intraoperative bleeding during nasal surgery and postoperative morbidity.
Results
The treatment group showed significant improvements in intraoperative bleeding, the surgical field, and surgeon satisfaction compared to the control group. However, the prophylactic use of desmopressin was associated with elevated blood pressure and decreased serum sodium levels compared to the control group. Nonetheless, no significant adverse effects were reported in the included studies. Subgroup analyses comparing the route of administration (intravenous vs. intranasal) and type of surgery (rhinoplasty vs. endoscopic sinus surgery) showed that desmopressin had a beneficial effect on intraoperative bleeding and the surgical field, regardless of the route of administration or type of surgery.
Conclusion
The prophylactic use of desmopressin for nasal surgery effectively reduced intraoperative bleeding, improved the surgical field, and increased surgeon satisfaction, with no significant adverse effects. However, caution should be exercised when administering desmopressin as it may cause an elevation in postoperative blood pressure in patients with cardiopulmonary problems.

Keyword

Deamino arginine vasopressin; Endoscopes; Nose; Hemorrhage; Meta-analysis

Figure

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  Fig. 1. Study selection diagram.

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  Fig. 2. Preoperative administration of desmopressin versus placebo: standard mean difference in intraoperative bleeding. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

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  Fig. 3. Preoperative administration of desmopressin versus placebo: standard mean difference in the quality of the operative field. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

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  Fig. 4. Preoperative administration of desmopressin versus placebo: standard mean difference in surgeon satisfaction. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

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  Fig. 5. Preoperative administration of desmopressin versus placebo: standard mean difference in operative time. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

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  Fig. 6. Preoperative administration of desmopressin versus placebo: standard mean difference in intraoperative arterial blood pressure. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

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  Fig. 7. Preoperative administration of desmopressin versus placebo: standard mean difference in postoperative serum sodium levels. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

Reference

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