Some aspects of blood loss and fluid balance in paediatric adenotonsillectomy.

Abstract

Attention has recently been drawn to the importance of assessing blood loss in paediatric surgery (Brit. med. 7., 1964), but little has been written about such loss in adenotonsillectomy (Shalom, 1964). In this investigation we have set out to measure the operative blood loss and the degree of pre-operative fluid depletion; the significance of these with regard to postoperative progress is discussed. The opportunity was also taken to compare the effects of two different anaesthetic sequences on the operative blood loss. MethodThe series consisted of 50 cases of dissection adenotonsillectomy taken in sequence and with no attempt at selection. Twenty-five were anaesthetized with ether and 25 with halothane by means of a Boyle-Davis gag in all cases.On arrival in hospital the patients were placed on fluid charts, and careful note was kept of all fluid intake in the 24-hour pre-operative period. Food and water were prohibited for the four hours prior to operation. For each child the predicted volumes of fluid necessary to maintain normal balance were calculated on a body-weight basis from a chart devised by Carre (1958). The deficit between the actual and the predicted intake was expressed as a percentage of the latter. Throughout the series the environmental conditions were constant, the children being nursed in the same ward under the same staff.Premedication was by oral pentobarbitone sodium (5 mg./kg.) and atropine (0.6 mg.) intramuscularly, given 60 Barr (1963). Blood loss was ascertained by measuring the volume of suctioned blood in graduated columns which contained an anticoagulant and silicone antifoam to prevent coagulation and clotting. Previously weighed dry gauze sponges were used and the quantity of blood soiling them was determined by immediate re-weighing. Gravimetric methods are convenient and simple, and they compare favourably with other methods (Baronofsky et al., 1946). Moreover, the method was checked against measured known volumes of blood, and the error was found to be + 2 %. Blood volume was taken to be 70 ml./kg. (Carre, 1963).The 50 cases included both sexes, and the average age was 7.3 years (range 2 to 12 years). The average weight was 26.1 kg. On admission the haemoglobin was measured in all patients, the average being 12.4 g./100 ml. (range 8.1-15.3 g.).Results Forty-nine patients had some deficit in their fluid requirement, the average being 57%, though 20 cases had a deficit of between 50% and 75% and in a further 11 it was more than

Measurement of Blood Loss during Adenotonsillectomy in Children and Factors Affecting It

“…So, age in children and the blood loss is not significant and patient's age doesn't have an impact on adenotonsillectomy blood loss. This finding correlates with Holden and Maher's [2] and Shalom's [13] study on blood loss measurement. In a study conducted by KC Prasad and SC Prasad [1], it was shown that the older the child is, the greater the blood loss is.…”

The properties of an improvised piston pump for the rapid delivery of intravenous fluids

“…Manual syringing of intravenous fluid may be desirable in three settings: first, if there is a need to control the volume tightly (e.g. in paediatric resuscitation) , secondly, if there is a need to use higher pressures to drive flow (e.g. with intra‐osseous devices) and thirdly, if it is necessary to introduce a small volume rapidly (e.g.…”

Sangrado intraoperatorio de amigdalectomía en población pediátrica. Influencia de factores quirúrgicos y anestésicos

“…Se determinó un sangrado intraoperatorio promedio de 41 ml, algo menor a lo observado en otros estudios [7]- [9]. Hubo una gran dispersión a causa de Figura 1.…”

“…La literatura con respecto al sangrado intraoperatorio es limitada. En 1965, Holden et al, estimó dicho sangrado en 128,1 ml en pacientes de 4 a 12 años [7], mientras que estudios más recientes sugieren 92,46 ml [8] y 73,7-79,8 ml en pacientes de 4 a 9 años [9]. A pesar de ser potencialmente severo, la tasa de transfusión asociada al sangrado intraoperatorio se mantiene baja (0%-3%), y a menudo se ve relacionada con alteraciones de la coagulación [10], [11].…”