Effect of Controlled Hypertension on Hemostasis Before Closure of the Operative Incision in Patients Undergoing Vertical Partial Laryngectomy: A Randomized Controlled Study

Abstract

Background: To evaluate the efficacy of controlled hypertension on hemostasis before closure of the operative incision in vertical partial laryngectomy (VPL).Methods: Seventy males scheduled for VPL were randomly assigned to Group H who received either ephedrine or phenylephrine to maintain a mean arterial pressure (MAP) of 90–110 mmHg 10 min before the operative incision closure or to Group N who received normal saline. The primary endpoint was the volume of drainage after surgery. Heart rate, MAP, surgical field bleeding score before and after drug administration, the amount of liquid administered, operation and recovery durations were recorded. Heart rate, MAP, incisional bleeding score, coughing score, nausea and vomiting score, and frequency of bloody sputum aspiration were also recorded when the patient left the postanesthesia care unit and at 6 and 24 hours postoperatively.Results: The intraoperative bleeding score of the surgical field was significantly higher in patients receiving vasopressor. The volume of drainage in control group was more than that in Group H at different time points after surgery. Compared with Group N, Group H had a significantly lower incisional bleeding score and frequency of bloody sputum aspiration at all time-points after surgery, and a significantly lower nausea and vomiting score at 6 and 24 hours postoperatively. Conclusion: Controlled hypertension (MAP 90–110 mmHg) before wound closure may be used as an alternative way to detect intraoperative bleeding points in patients undergoing VPL, which also decreased the postoperative volume of drainage and the incidences of nausea and vomiting.Trial registration: The China Clinical Research Information Service (registration number, ChiCTR1900026097). Registered 21 September 2019, http://www.chictr.org.cn/showproj.aspx?proj=37850

Effect of the Trendelenburg position on the homeostasis during and post thyroidectomy

“…Some studies have suggested that the Trendelenburg position is sensitive to the identification of bleeding vessels and is involved in bleeding control (8,14,15). However, a longer duration of this position may limit the procedure due to the risk of high intracranial pressure (11,15). Therefore, in the present study, the Trendelenburg position of 30 degrees was used for 4 min.…”

“…In addition, Ozdemir et al (2017) stated that the Valsalva maneuver helps detect more bleeding points after the Trendelenburg position (11), and therefore, reduces bleeding. Some studies have suggested that the Trendelenburg position is sensitive to the identification of bleeding vessels and is involved in bleeding control (8,14,15). However, a longer duration of this position may limit the procedure due to the risk of high intracranial pressure (11,15).…”