Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2012, vol. 21, nr 6, November-December, p. 773–780

Publication type: original article

Language: English

Comparison of Two Doses of Tranexamic Acid on Bleeding and Surgery Site Quality During Sinus Endoscopy Surgery

Porównanie wpływu dwóch dawek kwasu traneksamowego na krwawienia i jakości pola operacyjnego podczas endoskopowego zabiegu chirurgicznego zatok

Hamidreza Abbasi1,A, Shekoufeh Behdad1,D,E, Vida Ayatollahi1,E, Naderali Nazemian1,B, Parvaneh Mirshamsi1,B

1 Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

Abstract

Background. One of the main concerns in sinus surgery is blood loss due to the high vasculature of the mucosa. Tranexamic acid (TA) is an antifibrinolytic agent which reduces bleeding following certain surgical procedures.
Material and Methods. This randomized double-blinded clinical trial was performed on 70 patients with class I and II ASA (American Society of Anesthesiologists) who were scheduled for endoscopic sinus surgery under general anesthesia. The average ages of the patients were 18 to 50 years old. Thirty-five patients (group A) received 5 mg/Kg of TA, and another 35 patients (group B) received 15 mg/Kg of TA. The mean arterial pressure (MAP), diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) were documented. Also, the amount of blood loss and satisfaction scores were obtained from the surgeon in 30th, 60th, 90th, 120th and 180th minutes. All the data was analyzed by SPSS-15 software with T-test.
Results. A total of 52 males and 18 females participated in the study. There were no significant differences between the mean age, MAP, DBP, SBP and HR during surgery between groups. Blood loss was 272.74 ± 25.77 mL 242.89 ± 51.77 mL in the group A and B respectively (P < 0.003). The surgeon was more satisfied with the surgical field of the group B than the group A (mean scores 4 (3–5) vs. 3 (1–5) respectively, P < 0.005). Surgery period and need for supplement drug to control bleeding in group B was significantly less than in group A (P < 0.05). But there was no significant difference between the two groups in terms of side effects.
Conclusion. Administration of 15 mg/Kg TA intravenously is more effective than 5 mg TA to achieve hemostasis and improving the quality of surgical field, surgeon satisfaction, less surgery period and bleeding volume during endoscopic sinus surgery without any significant side effects.

Streszczenie

Wprowadzenie. Jednym z głównych problemów w chirurgii zatok przynosowych jest utrata krwi z powodu dużego unaczynienia błony śluzowej. Kwas traneksamowy (TA) jest środkiem antyfibrynolitycznym, który zmniejsza krwawienie po niektórych zabiegach chirurgicznych.
Materiał i metody. Do randomizowanego badania klinicznego z podwójnie ślepą próbą włączono 70 chorych klasy I i II wg ASA (Amerykańskie Stowarzyszenie Anestezjologów), u których wykonano planowy zabieg chirurgii endoskopowej zatok w znieczuleniu ogólnym. Wiek pacjentów wynosił 18–50 lat. 35 chorych (grupa A) otrzymało 5 mg/kg TA, a kolejne 35 osób (grupa B) otrzymało 15 mg/kg TA. Zmierzono średnie ciśnienie tętnicze (MAP), ciśnienie rozkurczowe (DBP), ciśnienie skurczowe (SBP) i częstość akcji serca (HR). Ponadto udokumentowano ilość utraconej krwi i uzyskano ocenę satysfakcji od chirurga w 30., 60., 90., 120. i 180. minucie. Wszystkie dane analizowano za pomocą oprogramowania SPSS-15 i testu T.
Wyniki. Łącznie 52 mężczyzn i 18 kobiet wzięło udział w badaniu. Nie stwierdzono istotnych różnic w średnim wieku, MAP, DBP, SBP i HR podczas operacji między grupami. Utrata krwi wynosiła 272,74 ± 25,77 ml i 242,89 ± 51,77 ml odpowiednio w grupie A i B (p < 0,003). Chirurg był bardziej zadowolony z pola operacyjnego w grupie B w porównaniu z grupą A (średnie wyniki 4 (3–5) vs 3 (1–5); p < 0,005). Czas operacji i konieczność stosowania dodatkowego leku hamującego krwawienie były mniejsze w grupie B niż w grupie A (p < 0,05). Nie było znaczącej różnicy między grupami pod względem działań ubocznych.
Wnioski. Podawanie 15 mg/kg TA dożylnie jest bardziej skuteczne niż 5 mg TA w celu osiągnięcia hemostazy, poprawy jakości pola operacyjnego, większej satysfakcji chirurga, skrócenia czasu zabiegu chirurgicznego i ograniczenia wielkości krwawienia podczas endoskopowego zabiegu chirurgicznego zatok, bez żadnych istotnych działań ubocznych.

Key words

tranexamic acid, bleeding, surgical field quality, endoscopic sinus surgery

Słowa kluczowe

kwas traneksamowy, krwawienie, jakość pola chirurgicznego, endoskopowa chirurgia zatok

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