Article

Induced Hypotension in the Control of Bleeding During the Fenestration Operation

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Abstract

Induced hypotension for the control of bleeding during operation, as first described by Gardner,1 has proved a new and valuable aid for the control of less severe but troublesome bleeding during delicate and confining types of operative procedure such as the fenestration operation.

In approximately 30 per cent of the cases submitted to the Lempert fenestration operation there is troublesome bleeding. This bleeding reduces the speed of the operator, and, because of the effort in removing the blood by irrigation and suction, added trauma is induced in the vicinity of delicate structures such as the ear drum, tympano-meatal flap, and the seventh nerve.

More important, however, is the complete control of bleeding during the preparation of the fenestra. A bloodless field is desirable, as any blood entering the fenestra must be removed from the perilymphatic space within the bony labyrinth. This removal increases the amount of trauma to the membranous labyrinth, and many times it is impossible to remove all of the visible blood even with irrigation and suction.

It therefore becomes obvious that any method of effective control of this bleeding is desirable.

The procedure of controlled induced hypotension has been used in 24 patients undergoing the fenestration operation. In all of these cases the troublesome bleeding encountered during the preparation of the tympano-meatal flap and the construction of the new fenestra has been satisfactorily controlled. The frequency and severity of postoperative labyrinthitis has been reduced, probably due to reduction of the amount of blood entering the fenestra and. . .


 

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