Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Comparison of Tranexamic Acid and Dexmedetomidine on Bleeding in Endoscopic Sinus Surgery

Document Type : Original

Authors
Mohammad Saeed Ahmadi 1
Javaneh Jahanshahi 1
Farnaz Hashemian 1
Ahmad Reza Salimbahrami 2
Negar Haghi 1
Elham Khanlarzadeh 3
1 Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran.
2 Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran.
3 Department of Social Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Iran
10.22038/ijorl.2022.64361.3203
Abstract
Introduction:
The quality of the surgical field during the surgery is impaired when bleeding occurs. This study compared the effect of tranexamic acid and dexmedetomidine on the rate of bleeding during endoscopic sinus surgery (ESS).
Materials and Methods:
In this one-blind clinical trial, 72 patients with chronic rhinosinusitis who were candidates for ESS at Be’sat Hospital in Hamedan were randomly assigned to two groups. Group A received dexmedetomidine at a dose of 1μg/kg, and group B received tranexamic acid at a dose of 10mg/kg immediately after induction of anesthesia intravenously within 15 minutes. The two groups were evaluated and compared regarding the quality of the surgery field with the Boezaart scale, volume of intraoperative bleeding, hemodynamic changes, and complications up to 90 minutes after the beginning of surgery.
 
Results:
The mean volume of intraoperative bleeding in group A (181.67±86.66) was significantly higher than in group B (110.28±61.23) (P =0.000). At 15, 30, and 60 minutes, the quality of the surgical field in group B was better than group A (P =0.038), while at 90 minutes, there was no statistically significant difference (P =0.450). The mean arterial pressure in group A at 15 minutes was higher than in group B (P=0.003); at 60 and 90 minutes, it was lower, and the difference was statistically significant (P =0.01). On the other hand, in 30 minutes, the mean arterial pressure in group A was higher than in group B, without a significant difference (P =0.07). Moreover, there was no statistically significant difference between the average surgery time (P = 0.25) and the frequency of complications (P =0.405).
Conclusions:
Based on the results, tranexamic acid is preferable to injectable dexmedetomidine to control and reduce bleeding during ESS.
 
Keywords
Chronic rhinosinusitis
Dexmedetomidine
Tranexamic acid
Sinus endoscopy
  1. Pleis JR, Lucas JW, Ward BW. Summary health statistics for US adults: National Health Interview Survey, 2008. Vital and health statistics Series 10, Data from the National Health Survey. 2009(242): 1-157.
  2. Anon JB. Upper respiratory infections. The American journal of medicine. 2010;123(4):S16-S25.
  3. Weir N. Infective rhinitis and sinusitis. Scott-Brown's Otolaryngology-Rhinology. 1997;4:39-40.
  4. Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. The Laryngoscope. 2004;114(5):923-30.
  5. Degoute C. Controlled hypotension: a guide to drug choice. Drugs. 2007;67(7):1053-76.
  6. Guven D, Demiraran Y, Sezen G. Evaluation of outcomesin patients given dexmedetomidine in functional endoscopicsinus surgery. Ann Otol Rhinol Laryngol. 2011;120(9):586-92.
  7. Cole JW, Murray DJ, Snider RJ, Bassett GS, Bridwell KH, Lenke LG. Aprotinin reduces blood loss during spinal surgery in children. Spine. 2003;28(21):2482-5.
  8. Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. Journal of clinical anesthesia. 2011;23(8):611-5.
  9. Nuhi S, Tabrizi AG, Zarkhah L, Ashrafi BR. Impact of intravenous tranexamic acid on hemorrhage during endoscopic sinus surgery. Iranian journal of otorhinolaryngology. 2015; 27(82):
  10. Marchal J, Gómez‐Luque A, Martos‐Crespo F, Sanchez De La Cuesta F, Martínez‐López M, Delgado‐Martinez A. Clonidine decreases intraoperative bleeding in middle ear microsurgery. Acta anaesthesiologica scandinavica. 2001;45(5): 627-33.
  11. Puurunen MK, Gona PN, Larson MG, Murabito JM, Magnani JW, O'Donnell CJ. Epidemiology of venous thromboembolism in the Framingham Heart Study. Thrombosis research. 2016;145:27-33.
  12. Bagatini A, Gomes CR, Masella MZ, Rezer G. Dexmedetomidine: pharmacology and clinical application. Revista brasileira de anestesiologia. 2002; 52(5):606-17.
  13. De Bonis M, Cavaliere F, Alessandrini F, Lapenna E, Santarelli F, Moscato U, et al. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study. The Journal of thoracic and cardiovascular surgery. 2000; 119 (3): 575-80.
  14. Longstaff C. Studies on the mechanisms of action of aprotinin and tranexamic acid as plasmin inhibitors and antifibrinolytic agents. Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis. 1994;5(4):537-42.
  15. Katzung B. Basic & Clinical Pharmacology. 460-477. Appleton & Lange, Norwalk, Conneticut, USA. 1995:460-77.

 

  1. Zehtabchi S, Abdel Baki SG, Falzon L, Nishijima Tranexamic acid for traumatic brain injury: a systematic review and meta-analysis. Am J Emerg Med. 2014;32(12):1503-9.
  2. Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. J Clin Anesth.2011;23(8):611-5.
  3. Karimi A, Mohammadi SS, Hasheminasab M. Efficacy of tranexamic acid on blood loss during
    bimaxilary osteotomy: A randomized double blind clinical trial. Saudi J Anaesth. 2012;6(1):41-5.
  4. Modir H, Moshiri E, Naseri N, Faraji F, Almasi-Hashiani A. A randomized parallel design trial of the efficacy and safety of tranexamic acid, dexmedetomidine and nitroglycerin in controlling intraoperative bleeding and improving surgical field quality during septorhinoplasty under general anesthesia. Medical Gas Research. 2021;11(4):131.
  5. 20. Berenjian S, Hassani V, Farhadi M, Zaman B, Alimian M. Comparing the effect of Tranexamic acid and Dexmedetomidine on bleeding during Rhinoplasty. Anesthesiology and Pain. 2017; 7(4): 36-43.
  6. Mathew PJ, Jain A, Wig J, Mukherjee KK, Gupta A. Randomized Controlled Trial of Intravenous Dexmedetomidine for Control of Hemodynamics, Surgical Bleeding, and Recovery Profile during Transsphenoidal Pituitary Surgery. Journal of Neuroanaesthesiology and Critical
    2019.
  7. Karkhanehei B, Ahmadi MS, Seifrabiei MA. Evaluation of Intravenous Tranexamic Acid on Hemorrhage Volume and Quality of Surgery Field during Nasal Surgery. Avicenna Journal of Clinical Medicine. 2018;25(2):73-8.
Iranian Journal of Otorhinolaryngology
Volume 35, Issue 1
January and February 2023
Pages 49-56