CRCM  Vol.4 No.5 , May 2015
Measurement of Blood Loss during Adenotonsillectomy in Children and Factors Affecting It
ABSTRACT
This prospective study was done at the Southern Railway Headquarters Hospital, Ayanavaram, Chennai to measure the intraoperative blood loss during adenotonsillectomy and to assess the factors affecting it. Since blood volume in children is low, even a small loss will result in dreaded complications, so blood loss measurement in paediatric surgery is important. Adenotonsillectomy is the most common surgery performed in the field of otolaryngology, so blood loss measurement is essential in this surgery. In the study, 50 children who underwent adenotonsillectomy, by conventional dissection and snare method for tonsillectomy and curette method for adenoidectomy, were evaluated for operative blood loss. This study was conducted over a 1 year period, from June 2013 to June 2014. Both gravimetric method and blood volume studies were used to measure the operative blood loss. The estimated blood loss by gravimetric method was 94.35 ml, whereas the actual blood loss by blood volume studies was 90.57 ml and the average blood loss was 92.46 ml. The youngest child who was operated was 4 years old and the oldest child was 15 years old. The minimum blood loss was 40.30 ml and the maximum was 278.46 ml. In our series, operative blood loss was dependent on fibrosis of tonsil and the grade of the tonsil. There was no significant correlation between age and sex of the patient and the surgical skills.

Cite this paper
Manikandan, D. , Musarrat, F. , Preetham, A. and Anjali, R. (2015) Measurement of Blood Loss during Adenotonsillectomy in Children and Factors Affecting It. Case Reports in Clinical Medicine, 4, 151-156. doi: 10.4236/crcm.2015.45032.
References
[1]   Prasad, K.C. and Prasad, S.C. (2011) Assessment of Operative Blood Loss and the Factors affecting it in Tonsillectomy and Adenotonsillectomy. Indian Journal of Otolaryngology and Head & Neck Surgery, 63, 343-348.
http://dx.doi.org/10.1007/s12070-011-0268-9

[2]   Holden, H.B. and Maher, J.J. (1965) Some Aspects of Blood Loss and Fluid Balance in Paediatric Adenotonsillectomy. British Medicine Journal, 2, 1349-1351.
http://dx.doi.org/10.1136/bmj.2.5474.1349

[3]   Spoerell, W.E., Hersey, W.L. and Greenway, R.A. (1960) Blood Loss during Tonsillectomies in Children. Canadian Medical Association Journal, 82, 1265-1267.

[4]   Callanan, V., Curran, A.J., Smyth, D.A. and Gormley, P.K. (1995) The Influence of Bismuth Subgallate and Adrenaline Paste upon Operating Time and Operative Blood Loss in Tonsillectomy. The Journal of Laryngology & Otology, 109, 206-208.
http://dx.doi.org/10.1017/S0022215100129706

[5]   Boliston, T.A. and Upton, J.J. (1980) Infiltration with Lignocaine and Adrenaline in Adult Tonsillectomy. The Journal of Laryngology & Otology, 94, 1257-1259.
http://dx.doi.org/10.1017/S0022215100090071

[6]   De Reynier, J.P. (1959) Hemorrhage during Tonsillectomy. Pract Otorhinolaryngologica, 21, 18-23.

[7]   Maier, H.L. and Bogue, C.R. (1970) Measurement of Blood Loss during Tonsillectomy and Adenoidectomy. AORN Journal, 11, 62-66.

[8]   Thornton, J.A., Saynor, R., Schroeder, H.G., Taylor, D.G. and Verel, D. (1963) Estimation of Blood Loss with Particular Reference to Cardiac Surgery: Description of a Method. British Journal of Anaesthesia, 35, 91-99.
http://dx.doi.org/10.1093/bja/35.2.91

[9]   CahaliI, M.B., de Paula Soares, C.F., da Silva Dantas, D.A. and Formigoni, G.G.S. (2011) Tonsil Volume, Tonsil Grade and Obstructive Sleep Apnea: Is There Any Meaningful Correlation? Clinics, 66, 1347-1351.
http://dx.doi.org/10.1590/S1807-59322011000800007

[10]   Eipe, N. and Ponniah, M. (2006) Perioperative Blood loss Assessment—How Accurate? Indian Journal of Anaesthesia, 50, 35-38.

[11]   Gross, J.B. (1983) Estimating Allowable Blood Loss: Corrected for Dilution. Anesthesiology, 58, 277-280.
http://dx.doi.org/10.1097/00000542-198303000-00016

[12]   Davenport, H.T. and Barr, M.N. (1963) Blood Loss during Paediatric Operations. Canadian Medical Association, 89, 1309-1313.

[13]   Shalom, A.S. (1964) Blood Loss in Ear, Nose and Throat Operations. The Journal of Laryngology & Otology, 78, 734-756.
http://dx.doi.org/10.1017/S0022215100062691

[14]   Ruggles, R.L. (1960) Blood Loss during Adenoidectomy and Tonsillectomy Measured with Radioisotopes. Annals of Otology, Rhinology & Laryngology, 69, 360-374.
http://dx.doi.org/10.1177/000348946006900206

[15]   Lee, M.H., Ingvertsen, B.T., Kirpensteign, J., Jensen, A.L. and Kristensen, A.T. (2006) Quantification of Surgical Blood Loss. Veterinary Surgery, 35, 388-393.
http://dx.doi.org/10.1111/j.1532-950X.2006.00162.x

[16]   Johar, R.S. and Smith, R.P. (1993) Assessing Gravimetric Estimation of Intraoperative Blood Loss. Journal of Gynecologic Surgery, 9, 151-154.
http://dx.doi.org/10.1089/gyn.1993.9.151

[17]   Prasad, K.C. and Prasad, S.C. (2011) Assessment of Operative Blood Loss and the Factors affecting it in Tonsillectomy and Adenotonsillectomy. Indian Journal of Otolaryngology and Head & Neck Surgery, 63, 343-348.
http://dx.doi.org/10.1007/s12070-011-0268-9

[18]   Holden, H.B. and Maher, J.J. (1965) Some Aspects of Blood Loss and Fluid Balance in Paediatric Adenotonsillectomy. British Medicine Journal, 2, 1349-1351.
http://dx.doi.org/10.1136/bmj.2.5474.1349

[19]   Spoerell, W.E., Hersey, W.L. and Greenway, R.A. (1960) Blood Loss during Tonsillectomies in Children. Canadian Medical Association Journal, 82, 1265-1267.

[20]   Callanan, V., Curran, A.J., Smyth, D.A. and Gormley, P.K. (1995) The Influence of Bismuth Subgallate and Adrenaline Paste upon Operating Time and Operative Blood Loss in Tonsillectomy. The Journal of Laryngology & Otology, 109, 206-208.
http://dx.doi.org/10.1017/S0022215100129706

[21]   Boliston, T.A. and Upton, J.J. (1980) Infiltration with Lignocaine and Adrenaline in Adult Tonsillectomy. The Journal of Laryngology & Otology, 94, 1257-1259.
http://dx.doi.org/10.1017/S0022215100090071

[22]   De Reynier, J.P. (1959) Hemorrhage during Tonsillectomy. Pract Otorhinolaryngologica, 21, 18-23.

[23]   Maier, H.L. and Bogue, C.R. (1970) Measurement of Blood Loss during Tonsillectomy and Adenoidectomy. AORN Journal, 11, 62-66.

[24]   Thornton, J.A., Saynor, R., Schroeder, H.G., Taylor, D.G. and Verel, D. (1963) Estimation of Blood Loss with Particular Reference to Cardiac Surgery: Description of a Method. British Journal of Anaesthesia, 35, 91-99.
http://dx.doi.org/10.1093/bja/35.2.91

[25]   CahaliI, M.B., de Paula Soares, C.F., da Silva Dantas, D.A. and Formigoni, G.G.S. (2011) Tonsil Volume, Tonsil Grade and Obstructive Sleep Apnea: Is There Any Meaningful Correlation? Clinics, 66, 1347-1351.
http://dx.doi.org/10.1590/S1807-59322011000800007

[26]   Eipe, N. and Ponniah, M. (2006) Perioperative Blood loss Assessment—How Accurate? Indian Journal of Anaesthesia, 50, 35-38.

[27]   Gross, J.B. (1983) Estimating Allowable Blood Loss: Corrected for Dilution. Anesthesiology, 58, 277-280.
http://dx.doi.org/10.1097/00000542-198303000-00016

[28]   Davenport, H.T. and Barr, M.N. (1963) Blood Loss during Paediatric Operations. Canadian Medical Association, 89, 1309-1313.

[29]   Shalom, A.S. (1964) Blood Loss in Ear, Nose and Throat Operations. The Journal of Laryngology & Otology, 78, 734-756.
http://dx.doi.org/10.1017/S0022215100062691

[30]   Ruggles, R.L. (1960) Blood Loss during Adenoidectomy and Tonsillectomy Measured with Radioisotopes. Annals of Otology, Rhinology & Laryngology, 69, 360-374.
http://dx.doi.org/10.1177/000348946006900206

[31]   Lee, M.H., Ingvertsen, B.T., Kirpensteign, J., Jensen, A.L. and Kristensen, A.T. (2006) Quantification of Surgical Blood Loss. Veterinary Surgery, 35, 388-393.
http://dx.doi.org/10.1111/j.1532-950X.2006.00162.x

[32]   Johar, R.S. and Smith, R.P. (1993) Assessing Gravimetric Estimation of Intraoperative Blood Loss. Journal of Gynecologic Surgery, 9, 151-154.
http://dx.doi.org/10.1089/gyn.1993.9.151

 
 
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