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Canadian Journal of Anesthesia 52:A157 (2005)
© Canadian Anesthesiologists' Society, 2005

Abstracts - Tuesday June 21, 2005 1000-1200

TOPICAL TRANEXAMIC ACID FOR BLEEDING OF ENDOSCOPIC SINUS SURGERY

Mitra Jabalameli, MD and Kaveh Zakeri, MD

Department of Anesthesiology and Intensive care, Alzahra General Hospita, Sofe Boulevard, Isfahan, Iran

INTRODUCTION : Tranexamic acid(TA) is an antifibrinolytic agent to reduce bleeding following some surgical procedures(1,2,3) . It applied topically to achieve homeostasis(4) . We exmained the effect of topical tranexamic acid for providing a bloodless surgical field in patients undergoing endoscopic sinus surgery.We also evaluated the bleeding volume and grading under controlled hypotension .

METHODS: A prospective, randomized , double blind clinical trial was performed in 56 patients scheduled for elective endoscopic sinus surgery under general anesthesia. Twenty - six patients received topical tranextamic acid (1000 mg ) during surgery and 30 patients received placebo ( control group ) . The hemodynamic endpoint of the anesthetic management was maintenance of hypotension at 30 Percent lower than preoperative MAP for producing a bloodless surgical field . The desired control of the cardiovascular system was attained with halothane (inspired concentration increments of 0.5 vol % up to a maximum of 1.5 vol % ) ± hydralazine (100 µg/kg IV to a maximum of 40 mg ) as needed . Intraoperative bleeding was assessed on a six – point scale from 0 = no bleeding to 5 = severe bleeding .

RESULTS : There was less bleeding volume in the tranexamic acid group than in the placebo group ( 174 ± 10 vs 229 ± 23 ml , P<0.05) . Frequency of score 3 ( troublesome with repeated suction ) was lower in the tranexamic acid group than in the placebo group ( % 26 vs % 70 , P< 0.05 ) There was a significant difference in bleeding score between two groups ( 2.3 ± 0.2 in TA vs 2.5±0/15 in placebo group , P=0.00) .

DISCUSSION: Topical tranexamic acid provides more clear surgical field during endoscopic sinus surgery under general anesthesia with halothane and controlled hypotension . Also, it may be benefit in reducing bleeding from surgical wounds while minimizing systemic toxicity and thromboembolism than may occur with intravenous administration.

REFERENCES:

1 Acta orthop scand. 2001; 72(5) : 442–48 .[Medline]

2 Ann thorac surg. 2001; 72(5) : 470–75 .[Abstract/Free Full Text]

3 Lancet. 1991; 337:431.

4 Anesthesia, 2000; 55:600.





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