Article Type
Article
Abstract
Objectives: To evaluate applicability of tranexamic acid (TXA) infusion with normotensive anesthesia in comparison to hypotensive anesthesia during functional endoscopic sinus surgery (FESS).
Patients & Methods: The study included 70 patients allocated into two equal groups: Group H received hypotensive anesthesia and Group N received normotensive anesthesia. Anesthesia was maintained in both groups by isoflurane 1-2%, but in group H, MAC of isoflurane was adapted to maintain mean arterial blood pressure (MAP) values in range of 60-70 mmHg. In group N, 500 mg TXA (loading dose) was given 20 minutes before surgery followed by continuous TXA infusion
(1 mg/kg/min) till the end of surgery. Operative field bleeding and its visibility was graded using 6-point scale. For both groups, tranexamic acid (4 gm) was given if bleeding score was ≥3. Total amount of bleeding and operative times were recorded.
Results: All patients had smooth intraoperative course without uneventful events. Mean operative time was significantly longer in group H compared to group N. All patients had bleeding score in range of 1-4 with significantly higher scores in group H compared to group N. The frequency of patients had low bleeding score was significantly higher in group N compared to group H. Mean amount of intraoperative blood loss was significantly higher in group H compared to group N. Mean dose of tranexamic acid used in group N was 5.88±1.1; range: 3.9-7.8 gm. Thirteen patients (18.6%) required booster dose of tranexamic acid; 9 in group H and 4 in group N with significantly lower need in group N.
Conclusion: The applied regimen of TXA administration during FESS significantly minimized intraoperative bleeding, and improved surgical field visibility with subsequent significant reduction of operative time. Moreover, it spared the need for hypotensive anesthesia with its consequent hemodynamic changes and costs.
Keywords: Tranexamic acid infusion, FESS, Hypotensive anesthesia, Bleeding scores.
Recommended Citation
Fawzy MM, Ewieda TM.
Tranexamic Acid versus Hypotensive Anesthesia using Isoflurane for Improvement of Outcome of Functional Endoscopic Sinus Surgery.
Pan Arab J. Rhinol.
2014;
4 : -.
Available at:
https://pajr.researchcommons.org/journal/vol4/iss1/6
