Novel Application of a Surgeon-Operated Clysis Delivery System in Burn Surgery

Insufflation of epinephrine-containing solutions (clysis) has shown to decrease blood loss in burn surgery. Current delivery methods are associated with significant cost and may predispose burn patients to hypothermia. This was a proof-of-concept study to evaluate a novel surgeon-operated clysis delivery system. Our initial experience with a novel fluid management system is presented. Temperature, pressure, and volume of clysis was recorded. Patient and burn factors were evaluated and complications collected. Finally, a cost-effectiveness analysis was conducted. Thirty-seven consecutive cases comprising 22 adult patients (15/22, 68% male), with a mean age of 49 years (+/-19) were reviewed. The mean % total body surface area of all patients was 39 (+/-21.7). The mean temperature, pressure, and volume of administered clysis was 32.2 degrees Celsius (+/-4.4), 265.04 mmHg (+/-56.17), and 5805.8 mL (+/-4844.4), respectively. The mean dose of epinephrine administered was 14.5 mg (+/-12.1). The mean temperature variability was 1.1 °C (+/-1.2). The total mean of packed red blood cells (PRBC) transfused was 507.6 mL (+/-624.4). There were no recorded complications. We identified a cost savings of CAD 20,766 over the cases examined, compared to our conventional clysis delivery technique. This novel technique provides rapid and safe infiltration of warmed clysis in burn surgery. We were able to maintain intra-operative euthermia. In addition, this technique may be transfusion-sparing. The introduction of this method of clysis administration was associated with significant cost-savings. Future randomized study is necessary.