27586
document
Topical adrenaline in the control of intraoperative bleeding in adenoidectomy : a randomised , controlled trial . OBJECTIVES To evaluate the efficacy of topical racemic adrenaline ( RA ) ( Micronefrin ; Bird Products , Palm Springs , CA , USA ) in the control of intraoperative bleeding and the prevention of postoperative bleeding , laryngeal spasm and postoperative pain in adenoidectomy among children < 6 years of age . DESIGN Prospective , randomised , blinded and placebo-controlled trial . SETTING Kanta-Hame Central Hospital , a district referral center in Finland . PATIENTS A consecutive sample of 93 children undergoing outpatient adenoidectomy . INTERVENTION Patients were randomised to receive topical gauze sponges soaked in either 1:500 RA or 0.9 % sodium chloride ( physiological saline ) for 3 min after adenoidectomy . MAIN OUTCOME MEASURES Amount of intraoperative bleeding ( surgeons ' subjective estimate ) , need for additional packings , need for electrocautery , laryngeal spasm , postoperative bleeding and pain , duration of procedure and duration of patients ' stay in the operation room ( OR ) . RESULTS Adrenaline significantly decreased surgeons ' subjective estimate of the amount of intraoperative bleeding ( proportion of patients with significant decrease 67 versus 21 % , P < 0.001 ) , reduced the mean number of packings needed ( 0.6 versus 1.2 , P < 0.001 ) and use of electrocautery ( 22 versus 45 % , P = 0.015 ) , and shortened the mean duration of the procedure ( 13 versus 18 min , P = 0.043 ) and the mean stay in the OR ( 31 versus 35 min , P = 0.058 ) . The impact of adrenaline was even more pronounced among patients with extensive adenoids and/or profuse intraoperative bleeding . A slight elevation of heart rate was observed more often in the adrenaline group ( P = 0.043 ) . CONCLUSIONS Use of topical adrenaline can be recommended in adenoidectomy among children . It helps control the intraoperative bleeding , reduces the use of electrocautery and shortens the durations of procedure and stay in the OR .
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Intervention_Pharmacological
adrenaline
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Intervention_Pharmacological
racemic adrenaline ( RA )
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Intervention_Pharmacological
topical gauze sponges soaked
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Intervention_Pharmacological
RA
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Intervention_Control
0.9 %
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Intervention_Pharmacological
sodium chloride ( physiological saline )
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Intervention_Surgical
adenoidectomy
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Intervention_Pharmacological
Adrenaline
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Intervention_Pharmacological
adrenaline
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Intervention_Pharmacological
adrenaline
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Intervention_Pharmacological
adrenaline
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Outcome_Physical
intraoperative bleeding
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Outcome_Physical
intraoperative bleeding
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Outcome_Other
prevention of postoperative bleeding
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Outcome_Physical
laryngeal spasm and postoperative pain
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Outcome_Physical
intraoperative bleeding
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Outcome_Other
need for additional packings , need for electrocautery , laryngeal spasm , postoperative bleeding and pain , duration of procedure and duration of patients ' stay in the operation room ( OR )
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Outcome_Physical
amount of intraoperative bleeding
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Outcome_Other
number of packings needed
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Outcome_Other
use of electrocautery
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Outcome_Other
duration of the procedure
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Outcome_Other
stay in the OR
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Outcome_Physical
adenoids
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Outcome_Physical
intraoperative bleeding
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Outcome_Physical
elevation of heart rate
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Outcome_Physical
intraoperative bleeding
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Outcome_Other
electrocautery
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Outcome_Other
procedure and stay in the OR
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Participant_Condition
adenoidectomy
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Participant_Age
children < 6 years
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Participant_Sample-size
93
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Participant_Age
children
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Participant_Condition
extensive adenoids
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Participant_Condition
profuse intraoperative bleeding
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Participant_Age
children