Role of antral puncture in the treatment of sinusitis in the intensive care unit

Sinusitis and fever of unknown origin

It is relatively uncommon to document sinusitis as a cause of fever with much certainty. Therefore, investigation for sinusitis should be undertaken only after more likely causes have been excluded. and the actions taken should reflect the individual patient's circumstances. Aggressive evaluation and treatment should be geared to minimizing the patient's overall morbidity and to identifying the more aggressive forms of sinusitis and their potential complications.

A rational approach to the evaluation and treatment of the infected patient in the intensive care unit

Critically ill patients are at increased risk of acquiring nosocomial infections. A thorough clinical evaluation and the selection of appropriate diagnostic techniques are important elements in the evaluation of these patients. Nonetheless, this selection process can be difficult because of the wide spectrum of disease that is seen in the ICU and the lack of standardized studies that have evaluated the different diagnostic methods that are available. Many different antimicrobials are available for the treatment of ICU-acquired infections. Most antimicrobial regimens have not been evaluated in large-scale, prospective, randomized trials. Until this information is available, the clinician must make an effort to be familiar with the different clinical and epidemiologic variables that can be used to stratify patients at the moment of selecting antimicrobial therapy. The information provided in this article, used in association with good clinical judgment, will help the critical care physician provide optimal initial management of the infected patient in the ICU.

Otorhinolaryngological problems occurring within the intensive care unit

OBJECTIVE

An overview of common otorhinolaryngological (ORL) problems and procedures in the intensive care unit (ICU) is presented.

FOCUS

Diagnostic, management, and treatment aspects of some conditions are discussed with emphasis on the potential difficulties encountered in the ICU. Approach recommendations are outlined as well as a list of required basic equipment.

CONCLUSIONS

Otorhinolaryngology should be included in intensive care continuing medical education programs.

Local anesthesia with EMLA cream for maxillary sinus puncture

Maxillary sinus puncture is traditionally carried out through the lateral wall of the inferior nasal meatus under local anesthesia. One problem with it is that the insertion of a cotton-tipped applicator soaked in local anesthetic is painful. Patients also dislike waiting for the anesthetic effect with the metallic applicators in the nose. In this study, we present a new, well-tolerated method of topical anesthesia for maxillary sinus puncture via the inferior meatus of the nose. Twenty adult patients with maxillary sinus infection who were undergoing bilateral maxillary sinus puncture were studied. One side of each patient's nose was anesthetized with a cotton-tipped applicator moistened with a lidocaine-adrenaline solution (LA), and the other side was anesthetized with EMLA cream instilled with a suction needle and syringe; the sides were chosen randomly. The mean "application of anesthesia" pain score on a 100-mm visual analog scale was 39.2 for the LA side and 9.1 for the EMLA side (p < .01). The anesthesia required for puncture was reached more quickly on the EMLA side than on the LA side (p = .02). The mean puncture pain score was 25.1 with LA and 8.6 with EMLA (p = .01). Fourteen patients out of the 20 (70%) found EMLA more tolerable, 3 patients (15%) found no difference, and 3 patients (15%) preferred LA (p < .01). We conclude that EMLA is better-tolerated and quicker-acting than LA for local anesthesia in maxillary sinus puncture.