Combination of propofol and tranexamic acid as a protocol of providing optimal surgical condition in comparison with halothane during tympanoplasty

ABSTRACT

Tympanoplasty is accomplished under general anesthesia. One major drawback of general anesthesia is the increased bleeding encountered, which can interfere with optimal visualization of the microscopic surgical field. We performed a prospective study to compare the effect of combination of propofol and tranexamic acid as a protocol versus halothane on blood loss and the surgeon's subjective assessment of operating conditions during tympanoplasty. 40 patients undergoing tympanoplasty were randomly assigned to receive the mentioned protocol or halothane [n=20]. One surgeon, who was blinded to the anesthetic agent, performed all the operations, and assessed surgical condition, using a grading system of score as follow 1. minimal or no bleeding 2. modest bleeding 3. significant bleeding 4. severe bleeding. Results were compared in the two anesthetic groups using appropriate statistical tests. There was no difference between the duration of surgery or the intraoperative mean arterial pressure when comparing the two groups. Mean bleeding scores were less over time with above protocol. 80% of the patients had a satisfactory visualization of the surgical field in protocol group, while it was 45% in halothane group. General anesthesia, based on the combination of propofol and tranexamic acid may have the advantage of decreased bleeding compared with conventional inhalation agents, making tympanoplasty technically easier and safer by improving visualization of surgical field. This anesthetic technique may have other applications in otolaryngology, when bleeding within a confined space frequently can interfere with visibility