Keywords: Post-tonsillectomy, bleeding, airway (PubMed Search)
Post tonsillectomy hemorrhage occurs and 0.1-3% of post tonsillectomy patient's. It occurs typically greater than 24 hours after surgery and up to 4-10 days postoperatively. A survey of otolaryngologists showed that ED management strategies for active bleeding have included direct pressure, clot suction, silver nitrate, topical epinephrine, and thrombin powder.
This article was a case study demonstrating the use of nebulized tranexamic acid (TXA) for post tonsillectomy hemorrhage in a 3-year-old patient. The patient had a copious amount of oral bleeding and had failed treatment with nebulized racemic epinephrine and direct pressure was not an option due to the patient's cooperation and small mouth. 250 mg of IV TXA was given via nebulizer with a flow rate of 8 L. Bleeding stopped 5-7 minutes after completion of the nebulizer. The patient was then taken to the OR for definitive management. No adverse effects were noticed.
TXA in the pediatric population has been shown to decrease surgical blood loss and transfusions in cardiac, spine and craniofacial surgeries. Studies have also been done in pediatric patients with diffuse alveolar hemorrhage using doses of 250 mg for children less than 25 kg and 500 mg for those who are greater than 25 kg.
Bottom line: There are case reports of nebulized TXA use in the pediatric population with no adverse outcomes noted. More research is needed.
Schwarz W, Ruttan T, Bundick K. Nebulized Tranexamic Acid Use for Pediatric Secondary Post-Tonsillectomy Hemorrhage. Annals of Emergency Medicine 2018. Epub ahead of print.
"Kama matokeo ya uchunguzi wa ""post-tonsilectomy"" (pubmed) na ""post-tonsilectomy"" (pubmed) ni asilimia 0.3 ya wagonjwa wanaopigwa na upasuaji wa amonia." Kwa kawaida hufanyika zaidi ya masaa 24 baada ya upasuaji na hadi siku 4-10 baada ya upasuaji. Uchunguzi wa wataalamu wa utando na shingo ulionyesha kwamba mbinu za usimamizi wa ED kwa kutokwa na damu kwa bidii zimejumuisha shinikizo la moja kwa moja, kunyonya kwa kuganda, nitrati ya fedha, epinephrine ya eneo, na poda ya thrombin. Utafiti wa kesi ya matibabu ya ugonjwa wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utumbo wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando wa utando. Mgonjwa alikuwa na kiasi kikubwa cha kutokwa na damu kwa mdomo na alikuwa ameshindwa matibabu na nebulized racemic epinephrine na shinikizo la moja kwa moja halikuwa chaguo kutokana na ushirikiano wa mgonjwa na kinywa kidogo. Vipimo vya IVA-TXA vilitolewa kwa njia ya nebulizer na kiwango cha mtiririko wa 8 L. Kutokwa na damu kulisimama dakika 5-7 baada ya kukamilika kwa nebulizer. Kisha mgonjwa huyo akapelekwa kwenye chumba cha upasuaji ili apate matibabu ya mwisho. Hakuna athari mbaya zilizotambuliwa. THAAD inaonyesha kupunguza upungufu wa damu na transfusions katika upasuaji wa moyo, uti wa mgongo na craniofacial. Utafiti wa watoto na watoto wenye alveolar hemorrhage ulifanyika kwa kutumia kipimo cha 250 mg kwa watoto wenye uzito wa chini ya 25 kg na 500 mg kwa wale wenye uzito wa juu kuliko 25 kg. Kwa ujumla, kuna ripoti za kesi za matumizi ya nebulized TXA katika idadi ya watoto bila matokeo mabaya yaliyotambuliwa. Utafiti zaidi unahitajiwa. Schwarz W, Ruttan T, Bundick K. Nebulized Tranexamic Acid Matumizi kwa Pediatric Sekondari Post-Tonsillectomy Hemorrhage. Annals of Emergency Medicine, 2018 - Utafiti wa matibabu ya dharura Epub kabla ya kuchapishwa.