Optimization of the approach to conducting tonsillectomy

Abstract

Actuality: Recurrent tonsillitis considers to be one of the most common ENT diseases. Tonsillectomy as the method of recurrent tonsillitis’ treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how fast he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anesthetic management and perioperative medical hemostatic support. Aim: Our study aimed to optimize the approach to carry out tonsillectomy by preoperative application of the tranexamic acid 10% solution and optimize the approach to choosing between endotracheal anesthesia and local anesthesia. Materials and methods: Clinical studies were made among 212 patients with recurrent tonsillitis who went through a bilateral tonsillectomy. The patients were divided into three groups. The 1st group included 54 patients undergoing tonsillectomy using endotracheal anesthesia with the administration of tranexamic acid at the rate of 10 mg/kg of body weight. The 2nd group consisted of 97 patients undergoing tonsillectomy using local anesthesia. A 3rd (control) group included 61 patient undergoing tonsillectomy using endotracheal anesthesia. The first and control (3rd) groups of patients were compared to assess the efficacy of using tranexamic acid.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. Conclusions: tonsillectomy surgery using local anesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and lessincidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anesthesia. The use of tranexamic acid 10% significantly reduces the amount of blood loss, helps to reduce intraoperative complications, and lower the emergence of postoperative bleeding and its intensity.