Effects of tranexamic acid during endoscopic sinus surgery in children

This study was conducted to evaluate the effect of tranexamic acid [TA] on the intra-operative bleeding during the functional endoscopic sinus surgery [FESS] in children. A total of 100 children recruited to undergo FESS were randomized into two groups. Group I: Was given just after induction, intra-venous 25 mg/kg TA diluted in 10 ml of normal saline. Group II: Was given 10 ml of normal saline. Non-invasive blood pressure, heart rate, and quality of the surgical field were estimated every 15 min. Volume of bleeding and duration of the surgical procedure were recorded. Surgical field quality after 15 min revealed that seven patients in group I had minimal bleeding versus no one in group II, P=0.006. Meanwhile, 35 patients in group I had mild bleeding versus 26 patients in group II, P=0.064. Higher number of patients in group II than in group I had moderate bleeding, P=0006. Also, at 30 min, revealed that 10 patients in group I had minimal bleeding versus one patient in group II, P=0.004. Meanwhile, 37 patients in group I had mild bleeding versus 28 patients in group II, P=0.059. Higher number of patients in group II than in group I had moderate bleeding, P<0001. Duration of the surgeries and volume of bleeding were significantly less in tranexamic group than the placebo group, P<0.0001. Single intra-venous bolus dose of tranexamic in children during the FESS improves quality of surgical field, reduces intra-operative bleeding, and duration of surgery

Effects of preoperative beta-blocker on blood loss and blood transfusion during spinal surgeries with sodium nitroprusside-controlled hypotension

The present study sought to determine whether premedication with oral beta-blocker before hypotensive anesthesia with sodium nitroprusside could improve the quality of surgical field, decrease the blood loss, and decrease the need for homologous blood transfusion and duration of surgery. Eighty patients scheduled for spinal fixation surgery were included in a prospective, randomized, double-blinded study. Patients were classified into two groups: Group I received oral atenolol 50 mg twice one day before surgery; and Group II received placebo tablets identical in appearance to atenolol tablets for the same period and interval. All patients in both the groups received intraoperative sodium nitroprusside [SNP] as a hypotensive agent. Hemodynamic variables, amount of sodium nitroprusside used, quality of surgical field, and the amount of homologous blood transfusion and blood loss were compared between groups. Heart rate and amount of SNP used were significantly less [P < 0.0001] in the atenolol group, but no significant difference was found in intraoperative mean arterial blood pressure [MABP] between the two groups. The time of surgeries was significantly shorter in Group I than in Group II [185 +/- 15.21 vs 225 +/- 12.61 min], P < 0.0001. The quality of surgical field was better in Group I than in Group II in all times of measurements, P < 0.0001. The amount of blood loss and the amount of packed red blood cells transfused were significantly less in Group I than in Group II, P < 0.0001. No clinically significant complications were observed in either group. Premedication with oral atenolol 50 mg twice/day for one day before hypotensive anesthesia with SNP during spinal surgeries seems to be clinically safe and effective to reduce heart rate, amount of SNP used, amount of blood loss, and amount of blood transfused with better quality of surgical field

Acute normovolemic hemodilution versus controlled hypotensive anesthesia in major orthopedic surgery

The purpose of this study was to investigate the efficacy and safety of controlled hypotension versus ANH as blood conservation methods during major orthopedic surgery. Forty patients, assigned to receive either ANH [HT= 30%] or controlled hypotension. General anesthesia was induced by fentanyl 2micro gm/kg intravenously, thiopental Na 5mg/kg intravenously and atracurim 0.5mg/kg. After induction of anesthesia but before surgery, the patients were classified into two groups according to the technique of blood conservation used: group I [20 patients] acute normovolemic hemodilution. The volume of blood withdrawn has been replaced simultaneously by infusion of identical volume of hydroxyethyl starch 6% in order to maintain normovolemia. Group II [20patients]: controlled hypotensive anesthesia. A mean of 1000 ml blood was predonated [20% of the total blood volume] in hemodilutio group. Blood loss was, significantly higher in ANH group. The total loss was 1500mL [ANH] vs. 1200 mL [in hypotensive group], [p < 0.05]. The average amount of blood transfusion was 262.5 ml [ANH group] vs. 187.5 ml [hypotensive group]. 50% went through surgery without receiving blood [ANH] vs. 60% [hypotensive group]. No renal, neurological or cardiopulmonary complications were registered. Also there was slight but significant metabolic acidosis. The acidosis was metabolic in origin because PaCO2 was kept constant and [Bic] and [BE] decreased significantly and it was not lactic acidosis as serum lactate remains within normal limit. It is considered as hyperchloermic metabolic acidosis as serum chloride significantly increased. Both ANH and hypotensive anesthesia can be used safely in patients undergo major orthopedic surgery however, Deliberate hypotension was the most effective means of reducing intraoperative bleeding and the time for this procedure was shorter than for normovolaemic haemodilution combined with autotransfusion. Also there was slight but significant metabolic acidosis