Hydrogen Peroxide as a Haemostatic Agent in Tonsillectomy Bleed: An Overview (original) (raw)
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Hydrogen Peroxide 3%: Is it Beneficial in Tonsillectomy?
Sultan Qaboos University medical journal, 2008
The world over, tonsillectomy is one of the operations most frequently performed by otolaryngologists, who are in search of a technique of tonsillectomy where the operation time and operative blood loss is reduced. This study was carried out to evaluate the effect of hydrogen peroxide 3% on tonsillectomy times, blood loss during the surgery and on the number of ties used. A pilot study of 30 patients was carried out in the Department of Otolaryngology of Basrah General Hospital, Iraq, in the period from February to July 2006. Tonsillectomy was performed using hydrogen peroxide 3% as a haemostatic agent in Group A (n = 15), while in Group B (n = 15) no agent was used with the gauze pack. The application of hydrogen peroxide 3% in the tonsillar fossae reduced the operation time by 31%, the operative blood loss by 32.9% and also reduced the number of ties used by 50% in Group A. All these results are statistically significant. The local application of 3% hydrogen peroxide on the tonsil...
Hydrogen Peroxide Mouth Rinse: An Analgesic Post-Tonsillectomy
The Journal of Otolaryngology, 2005
Objective: To compare the analgesic efficacy of hydrogen peroxide (H2O2) mouth rinse with control for post-tonsillectomy pain management. Design: Double-blinded, prospective, randomized, controlled clinical trial.
Balneo Research Journal, 2020
Recurrent tonsillitis is one of the most common ORL diseases. Tonsillectomy, as a method of surgical treatment associated with blood loss, and is accompanied by frequent perioperative bleeding. For the control of bleeding, it is advisable to use fibrinolysis inhibitors, one of which is tranexamic acid (TA). The study aimed to optimize the approach to performing tonsillectomy by preoperative application of a TA solution to reduce the volume of perioperative blood loss. Clinical studies were performed in 107 patients with recurrent tonsillitis who underwent bilateral tonsillectomy. The patients were divided into two groups. In the 1 st (main) group of 54 patients in the preoperative period was administered a 10% solution of TA at the rate of 10 mg/kg body weight. The 2 nd (control) group consisted of 53 patients without the use of TA. The efficacy of using tranexamic acid was evaluated by clinical (surgery time, the volume of blood loss intraoperatively, accounting for postoperative events, evaluation of the incidence of postoperative bleeding), and laboratory data (baseline and postoperative levels of D-dimer, level of soluble fibrin complexes. In group 1, a statistically significant decrease in the volume of blood loss, a decrease in the frequency of occurrence of intraoperative complications, postoperative bleeding, and a reduction in the triviality of the operation were determined. According to laboratory data, in patients of this group, the increase in the content of fibrin lysis products, the extension of thrombin time was significantly less pronounced than in the 2nd comparison group. The use of 10% TA solution before performing bilateral tonsillectomy leads to a decrease in blood loss, frequency, and the degree of occurrence of perioperative complications. Due to this, the duration of the operation of bilateral tonsillectomy is reduced.
Incidence of haemorrhage after tonsillectomy
Bangladesh Journal of Otorhinolaryngology, 2012
Tonsillectomy is probably the most common operation performed by an Otolaryngologist. One of the most significant complications is post-operative haemorrhage. Episodes of post tonsillectomy haemorrhage are unpredictable and sometimes life threatening. The aim of the present study was to find out the incidence of reactionary haemorrhage after tonsillectomy. A prospective study was conducted at Shaheed Shamsuddin Ahmed Hospital, Sylhet from April 2010 to March 2011. We had selected 112 cases undergoing tonsillectomy. Tonsillectomy was done by cold steel dissection technique and bipolar diathermy haemostasis. Post operatively every patient was treated with pain killer (diclofenac sodium and paracetamol), antibiotics (amoxicillin and cloxacillin) and hydrogen peroxide mouth wash. Postoperative follow-up was done till the tonsillar fossa healed. The incidence of reactionary haemorrhage was 2.68%, primary and secondary haemorrhage was 0%. In our series haemorrhage (2.68%) was higher than ...
Can a Surgical Technique Be a Risk for Post-tonsillectomy Haemorrhage? Our Point of View
Archives of Otorhinolaryngology-Head & Neck Surgery, 2018
Adenotonsillar disease and the surgical treatments reveal that this condition may still raise concerns leading to the formulation of several guidelines [1,2], particularly in relation to potential post-operative complications [3]. Studies in literature present no uniform results regarding the general frequency of post-tonsillectomy haemorrhage [3] and the possible relationship between the type of surgical technique employed and the rate of haemorrhagic complications [4,5]. Post-tonsillectomy bleeding represents one of the most feared complications and constitutes an important cause of medical-legal dispute in otolaryngologic field [6]. Recent national guidelines on the appropriateness of tonsillectomy [7], as well as the studies specifically devoted to the safety of surgical techniques in tonsillectomy [8-12], give particularly rigid addresses that appear to be in contrast with some clinical research data [8,10,13,14] and that deserve a greater critical examination. The present study has set out to verify the frequency of post-tonsillectomy haemorrhagic complications and the possible differences in post-tonsillectomy haemorrhage rate according to the most employed surgical techniques. Materials and Methods A MEDLINE inquiry was carried out using PubMed, Scopus, and Inter-Wiley as database, inserting the keywords "post-tonsillectomy haemorrhage" and "post-tonsillectomy bleeding", and restricting the research to the studies published between 2000 and 2015. In total, 231 studies were identified. From these, the multi-centric English language papers were extrapolated, in which the three most commonly used dissection and haemostasis techniques [15] were analysed: cold dissection with cold haemostasis (CD/CH), in which the tonsillar dissection is achieved by the use of cold traditional instruments (scalpel, scissors, scaler) and the haemostasis is obtained by compression and ligature of blood vessels; cold dissection with hot haemostasis (CD/HH), in which the cold steel dissection is in combination with diathermy for haemostasis; hot dissection with hot haemostasis (HD/HH), in which the dissection and haemostasis are achieved by diathermy. The examined studies analysed such surgical techniques in relation to the percentage of post-surgical haemorrhage primary (occurring within the first 24 hours after surgery), secondary (occurring after 24 hours from surgery), and total, regardless of whether it had been necessary to return to the theatre to stop the bleeding.
Does Surgical Technique Influence Post-Tonsillectomy Haemorrhage? Our Experience
Acta Otorrinolaringologica (english Edition), 2015
Introduction and objectives: Tonsillectomy represents one of the main surgical procedures for the otolaryngologist, with haemorrhage being the most common postoperative. The objective of this study was to determine the post-tonsillectomy haemorrhage rate, and relate the surgical technique, diagnosis and patient age. Methods: This was a retrospective study, from April 2012 to January 2014, covering 429 patients. We used the following surgical-dissection techniques: cold, Colorado needle and monopolar forceps. Haemostasis was carried out in every case with monopolar forceps and gauze compression. Results: Post-tonsillectomy haemorrhage rate was 6.99%. According to the surgical technique used, with Colorado needle dissection, the bleeding rate we found was 7.07%; with monopolar forceps dissection, the rate was 20.4%; and with cold dissection, 2.9%. Of all haemorrhages, only 9 (2.09%) needed reintervention, of which 40% were performed with monopolar forceps dissection. The group with the largest bleeding rate was that of more than 14 years old. The diagnosis most associated with bleeding was peritonsillar abscess. Conclusion: The lowest bleeding rate was found with cold dissection and monopolar forceps haemostasis (2.09%). Consequently, based on our experience and the results obtained in the study, we consider that surgical technique does influence post-tonsillectomy haemorrhage.
Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study
Medical Archives
Introduction: Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate. Aims: To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists. Methods: We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1 st 2015 and October 31 st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis). Results: 1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012). Conclusion: We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.
Intensity of hemorrhage following tonsillectomy
Vojnosanitetski pregled, 2012
Background/Aim. Although post-tonsillectomy hemorrhage is one of the most frequent and potentially life-threatening complications, there is no generally accepted classification of post-operative bleeding intensity. The aim of this study was to evaluate the intensity of post-tonsillectomy hemorrhage according to the five-grade classification. Methods. A total of 408 consecutive patients, aged 2 to 54 years, undergoing elective tonsillectomy, with (n=261) or without (n=147) adenoidectomy, were included in this prospective study. Tonsillectomy was performed under general anesthesia using standard technique of cold dissection with a snare. Any bleeding event was recorded. The severity of post-operative hemorrhage was classified in five grades. Results. In 11 (2.70%) of the patients grade 1 hemorrhage following tonsillectomy occurred, 4 (0.98%) had grade 2 and 2 (0.49%) of the patients had grade 3 post-operative bleeding. Grades 4 and 5 were not recorded, and no patient received a blood ...
Post-tonsillectomy hemorrhage: an assessment of risk factors
International Journal of Pediatric Otorhinolaryngology, 1996
Hemorrhage is the most frequent complication of tonsillectomy and is responsible for the majority of post-tonsillectomy fatalities. The incidence of this hemorrhage has been reported to be as high as 20% [6]. Despite continued efforts to reduce this problem, it remains a persistent risk. The charts of 1138 patients who underwent tonsillectomy with or without adenoidectomy from 7-l-89 to 6-30-93 were reviewed. Post-tonsillectomy hemorrhage occurred in 36 patients (3%). Preoperative, intraoperative and postoperative risk factors were assessed. Postoperative bleeding occurred more often in older patients (69% over age 11 years). Seventy-five per cent of these patients were operated on for chronic tonsillitis as compared to 11% operated on for upper airway obstruction. The majority of these patients presented after postoperative day 1 (83%). Four patients required blood transfusions. Postoperative hemorrhage occurred in 14% of patients with elevated postoperative mean arterial pressures. Intraoperative blood loss that exceeded 50 cm3 was also a significant risk factor for post-tonsillectomy hemorrhage. It is concluded that older age, a history of chronic tonsillitis, excessive intraoperative blood loss and elevated postoperative mean arterial pressure are significant risk factors for post-tonsillectomy hemorrhage. An awareness of these risk factors can help identify patients with potential to bleed postoperatively.