Intraoperative bleeding of tonsillectomy in pediatric patients. Effects of surgical and anesthesia technique

Abstract

Introduction: Tonsillectomy with or without adenoidectomy is one of the most frequent surgeries in the pediatric population. It has become predominantly an outpatient procedure. Therefore, it is of utmost importance identifying the factors that influence the intraoperative bleeding to prevent postoperative complications and rehospitalization. Material and Methods: An observational cross-sectional study was carried out. Patients between 1 and 14 years old that underwent to tonsillectomy with or without adenoidectomy since November 2015 to May 2017 were included. 709 cases were evaluated. Intraoperative bleeding was assessed by the volumetric method. A multivariate analysis was performed using a generalized linear regression model. Results: The average intraoperative bleeding was estimated in 1.9 ml/kg (95% CI: 1.7 -2.05). The use of propofol (30% increase in bleeding) and surgical time (2% increase for every minute) were risk factors. The use of electrocautery was associated with a 50% decrease in bleeding in comparison with conventional dissection (p = 0.001). Conclusions: The use of propofol and a prolonged surgical time were risk factors for intraoperative bleeding. The use of electrosurgery was a protective factor.