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Does tranexamic acid improve intra-operative visualisation in endoscopic ear surgery? A double-blind, randomised, controlled trial

Published online by Cambridge University Press:  13 November 2019

A Das ,
S Mitra ,
D Ghosh ,
S Kumar  and
A Sengupta
A Das
Affiliation:
Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
S Mitra*
Affiliation:
Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
D Ghosh
Affiliation:
Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
S Kumar
Affiliation:
Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
A Sengupta
Affiliation:
Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
*
Author for correspondence: Dr Sandipta Mitra, Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, 244 AJC Bose Road, Kolkata 700020, India E-mail: onlysandipta@gmail.com
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Abstract

Objective

To assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.

Methods

Fifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.

Results

The Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.

Conclusion

Tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.

Keywords

Otologic Surgical ProceduresEndoscopyHemorrhageTranexamic Acid
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 12 , December 2019 , pp. 1033 - 1037
Copyright
Copyright © JLO (1984) Limited, 2019

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Footnotes

Dr S Mitra takes responsibility for the integrity of the content of the paper

References

1Anschuetz, L, Bonali, M, Guarino, P, Fabbri, FB, Alicandri-Ciufelli, M, Villari, D et al. Management of bleeding in exclusive endoscopic ear surgery: pilot clinical experience. Otolaryngol Head Neck Surg 2017;157:700–6CrossRefGoogle ScholarPubMed
2Kozin, ED, Remenschneider, AK, Shah, PV, Reardon, E, Lee, DJ.Endoscopic transcanal removal of symptomatic external auditory canal exostoses. Am J Otolaryngol 2015;36:283–6CrossRefGoogle ScholarPubMed
3Zhang, Y, Bai, Y, Chen, M, Zhou, Y, Yu, X, Zhou, H et al. The safety and efficiency of intravenous administration of tranexamic acid in coronary artery bypass grafting (CABG): a meta-analysis of 28 randomized controlled trials. BMC Anesthesiol 2019;19:104CrossRefGoogle ScholarPubMed
4Cao, G, Chen, G, Huang, Q, Huang, Z, Alexander, PG, Lin, H et al. The efficacy and safety of tranexamic acid for reducing blood loss following simultaneous bilateral total knee arthroplasty: a multicenter retrospective study. BMC Musculoskelet Disord 2019;20:325CrossRefGoogle ScholarPubMed
5Boezaart, AP, van der Merwe, J, Coetzee, A.Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 1995;42:373–6CrossRefGoogle ScholarPubMed
6Athanasiadis, T, Beule, A, Embate, J, Steinmeier, E, Field, J, Wormald, PJ.Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study. Laryngoscope 2008;118:314–19CrossRefGoogle ScholarPubMed
7Alicandri-Ciufelli, M, Pingani, L, Mariano, D, Anschuetz, L, Molinari, G, Marchioni, D et al. Rating surgical field quality in endoscopic ear surgery: proposal and validation of the “Modena Bleeding Score”. Eur Arch Otorhinolaryngol 2019;276:383–8CrossRefGoogle Scholar
8Langille, MA, Chiarella, A, Côté, DW, Mulholland, G, Sowerby, LJ, Dziegielewski, PT et al. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 2013;3:315–18CrossRefGoogle ScholarPubMed
9El Shal, S, Hasanein, R.Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egypt J Anaesth 2015;31:1–7CrossRefGoogle Scholar
10Ping, WD, Zhao, QM, Sun, HF, Lu, HS, Li, F.Role of tranexamic acid in nasal surgery: a systemic review and meta-analysis of randomized control trial. Medicine (Baltimore) 2019;98:e15202CrossRefGoogle ScholarPubMed