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Intraoperative Use of QuikClot During Adenotonsillectomy: A Prospective Pediatric Trial
Craig S Derkay1, Hind A Baydoun2, Laura Stone3
1Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA Craig.derkay@chkd.org.
Insights
This study shows that using QuikClot for hemostasis during intracapsular tonsillectomy and adenoidectomy in children leads to faster recovery and reduced pain medication use. These findings suggest improved patient outcomes for this common pediatric surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Hemostasis
Background:
- Intracapsular adenotonsillectomy aims for hemostasis with minimal cauterization to improve patient recovery.
- Faster return to normal diet and activity, along with reduced narcotic use, are desired outcomes post-surgery.
Purpose of the Study:
- To evaluate the efficacy of QuikClot in enhancing hemostasis during intracapsular microdebrider tonsillectomy with adenoidectomy.
- To assess the impact of this technique on patient recovery times and pain management.
Main Methods:
- A prospective, nonrandomized study of 100 children undergoing intracapsular microdebrider tonsillectomy with adenoidectomy.
- Data collected included procedure time, cauterization time, estimated blood loss, and recovery metrics.
Main Results:
- Mean recovery to normal diet was 3.4 days, normal activity 2.8 days, and cessation of narcotics 3.0 days.
- No major complications such as bleeding or dehydration were observed in the 100 patients.
- Total cautery time was significantly correlated with the time to complete recovery (P<.05).
Conclusions:
- Intracapsular microdebrider tonsillectomy with adenoidectomy using QuikClot for hemostasis offers improved recovery times.
- This technique appears to yield better outcomes compared to previously reported methods for pediatric adenotonsillectomy.
Background:
Achieving hemostatic control after intracapsular adenotonsillectomy with minimal cauterization may potentially lead to improved outcomes with respect to return to normal diet, normal activity, and less use of narcotic pain medications.
Methods:
A prospective, nonrandomized, consecutive series of children with obstructive tonsils and adenoids at a tertiary children's hospital was undertaken.
Results:
One hundred consecutive children (52 boys/48 girls) ages 0-16 (mean=4.8, SD=3.7, median=4.0) years were recruited with complete data available on all 100. Mean total procedure time was 19.8 (SD=4.3, median=19.5) minutes, including mean total cauterization time of 155.3 (SD=59.7 seconds, median=143.0) (adenoids: mean=60.9, SD=31.5, median=53.0; tonsils: mean=94.5, SD=41.9, median=82.0) minutes. Mean estimated blood loss was 29.4 (SD=40.9, median=25.0) ml. There were no major complications (0/100 episodes of bleeding or dehydration after surgery). Mean return to normal diet was 3.4 (SD=2.2, median=3.0) days; mean return to normal activity was 2.8 (SD=2.1, median=3.0) days, and mean days to no further narcotics was 3.0 (SD=2.3, median=2.0) days. Mean days to complete recovery (normal diet, normal activity, and no narcotics) was 4.5 (SD=2.1, median=4.0, range: 1-10). Total cautery time was significantly correlated with time to complete recovery (P<.05).
Conclusions:
Intracapsular microdebrider tonsillectomy with adenoidectomy utilizing QuikClot to enhance the hemostasis results in recovery times better than previously reported for this common operation in children.
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