Department of Anaesthesia, ICU and Pain Management, Ain Shams University, Cairo, Egypt.
Department of Otorhinolaryngology, Ain Shams University, Cairo, Egypt.
Head Neck. 2021 May;43(5):1389-1397. doi: 10.1002/hed.26610. Epub 2021 Jan 31.
Intraoperative bleeding during functional endoscopic sinus surgery (FESS) poses a challenge to both surgeon and anesthetist. The primary aim of this study was to evaluate the effectiveness of local, intravenous and combined use of tranexamic acid (TA) in improving the surgical field quality during FESS.
We conducted a randomized controlled double-blinded prospective trial on 120 patients scheduled for elective FESS. After induction of general anesthesia, patients were randomly and evenly assigned to one of four groups; IV TA, local TA, both IV and local TA, and placebo. Surgical field was assessed using five-point Boezaart scale. Total fentanyl and esmolol consumption, operative time, recovery time, and postoperative complications were recorded.
Surgical field quality score was the best in IV and local TA group compared to others (p < 0.001). Mean operative time was found significantly shorter in IV and local TA group than placebo one. Total fentanyl consumption was significantly lower in IV and local TA group comparing to others (p = 0.025). Mean recovery time was significantly shorter for IV and local TA group compared to others. Total fentanyl consumption was significantly lower in IV and local TA group comparing to others. No significant differences were found of mean arterial pressure and heart rate decline in four groups. None of the patients in four groups required esmolol administration. No statistically significant differences were found in change of hemoglobin, hematocrit, prothrombin time, and partial thromboplastin time over time in all groups.
The combined use of topical and intravenous TA provided the best surgical field in FESS, less fentanyl consumption, and less recovery time without causing significant side effects.
功能性内窥镜鼻窦手术（FESS）过程中的术中出血给外科医生和麻醉师都带来了挑战。本研究的主要目的是评估局部、静脉内和联合使用氨甲环酸（TA）对内窥镜鼻窦手术中改善手术视野质量的效果。
我们对 120 名计划接受选择性 FESS 的患者进行了一项随机对照、双盲、前瞻性试验。全身麻醉诱导后，患者被随机分为四组；静脉 TA、局部 TA、静脉和局部 TA 联合使用以及安慰剂。使用五点 Boezaart 量表评估手术视野。记录总芬太尼和艾司洛尔的用量、手术时间、恢复时间和术后并发症。
与其他组相比，静脉和局部 TA 组的手术视野质量评分最佳（p<0.001）。与安慰剂组相比，静脉和局部 TA 组的平均手术时间明显缩短。与其他组相比，静脉和局部 TA 组的总芬太尼用量明显较低（p=0.025）。与其他组相比，静脉和局部 TA 组的平均恢复时间明显缩短。与其他组相比，静脉和局部 TA 组的总芬太尼用量明显较低。四组之间的平均动脉压和心率下降没有显著差异。四组均无需给予艾司洛尔。四组的血红蛋白、红细胞压积、凝血酶原时间和部分凝血活酶时间在时间上均无显著变化。
局部和静脉 TA 的联合使用在 FESS 中提供了最佳的手术视野，减少了芬太尼的用量和恢复时间，且没有引起明显的副作用。
