Impact of anesthetic management and use of tranexamic acid on outcomes in tonsillectomy.

Abstract

Recurrent tonsillitis is one of the most common pathologies in otorhinolaryngology. The proportion of tonsillectomies varies from 10% to 20% of all surgical interventions in the otorhinolaryngological departments. Important factors for tonsillectomy are the duration of operation, the amount of blood loss, postoperative complications, the general condition of the patient in the postoperative period, the severity of pain, the time of the hospital stay. The type of anesthesia and postoperative medical hemostatic support can have a significant impact on these factors. Our study aimed to optimize the approach to carry out tonsillectomy by preoperative application of the tranexamic acid 10% solution (TXA) and choosing between general and local anesthesia. Clinical studies were made among 212 patients with recurrent tonsillitis who went through a bilateral tonsillectomy. The patients were divided into three groups. The first group included 54 patients undergoing tonsillectomy using general anesthesia with the administration of TXA at the rate of 10 mg/kg of body weight. The second group consisted of 97 patients undergoing tonsillectomy using local anesthesia. A third control group included 61 patient undergoing tonsillectomy using general anesthesia. The first and control (third) groups of patients were compared to assess the efficacy of using TXA. Factors such as the duration of the surgery, the amount of blood loss, intraoperative events, the number of incidents of primary and secondary bleeding, and laboratory data were considered. The second and control (third) groups were compared to evaluate the impact of anesthetic management. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period. We conclude that tonsillectomy using local anesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and less incidents of primary and secondary bleeding. The average level of pain is higher in patients using general anesthesia. The use of TXA significantly reduces the amount of blood loss, intraoperative complications, and lower the emergence of postoperative bleeding and its intensity.