Harshita Pant, BMBS, PhD, Editor

Carl H. Snyderman, MD, MBA, Editor

The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is haemorrhage.

This issue of Otolaryngologic Clinics of North America addresses a matter of importance for every surgeon with every surgical encounter. In some circumstances, intraoperative hemorrhage is a life-threatening situation. In most cases, poorly controlled hemorrhage is a nuisance that slows the surgery and makes operating more difficult. Intraoperative bleeding impedes visualization and obscures normal anatomical landmarks. Poor visualization due to bleeding is probably the number one factor for avoidable complications such as injury of a nerve or major vessel. There is additional avoidable morbidity associated with perioperative anemia and hypovolemia, and their treatment. The hidden economic costs of operative bleeding are the management of complications, incomplete surgery, administration of blood products, decreased operative inefficiency, lost productivity of patients and families, and medicolegal issues.

The management of operative bleeding begins with prevention. Recognition of risk factors and stratification of patients into risk categories can help avoid many problems. With the increased use of long-acting irreversible antiplatelet drugs and other anticoagulants, patients are at greater risk for a bleeding complication. Common use of nonprescription drugs and herbal products contributes to the risk.

All of these topics are tackled in this issue of Otolaryngologic Clinics of North America , which starts with preoperative screening and preparation of patients and continues with discussions of hemostatic materials and techniques with specific recommendations for all types of otolaryngologic procedures and high-risk patient populations. The authors are acknowledged experts in their areas and bring a global perspective to this topic. We hope that this issue of Otolaryngologic Clinics of North America will become an indispensable resource for you as you wage the battle against bleeding.