Intraoperative Use of QuikClot During Adenotonsillectomy: A Prospective Pediatric Trial.

BACKGROUND

Achieving hemostatic control after intracapsular adenotonsillectomy with minimal cauterization may potentially lead to improved outcomes with respect to return to normal diet, normal activity, and less use of narcotic pain medications.

METHODS

A prospective, nonrandomized, consecutive series of children with obstructive tonsils and adenoids at a tertiary children's hospital was undertaken.

RESULTS

One hundred consecutive children (52 boys/48 girls) ages 0-16 (mean=4.8, SD=3.7, median=4.0) years were recruited with complete data available on all 100. Mean total procedure time was 19.8 (SD=4.3, median=19.5) minutes, including mean total cauterization time of 155.3 (SD=59.7 seconds, median=143.0) (adenoids: mean=60.9, SD=31.5, median=53.0; tonsils: mean=94.5, SD=41.9, median=82.0) minutes. Mean estimated blood loss was 29.4 (SD=40.9, median=25.0) ml. There were no major complications (0/100 episodes of bleeding or dehydration after surgery). Mean return to normal diet was 3.4 (SD=2.2, median=3.0) days; mean return to normal activity was 2.8 (SD=2.1, median=3.0) days, and mean days to no further narcotics was 3.0 (SD=2.3, median=2.0) days. Mean days to complete recovery (normal diet, normal activity, and no narcotics) was 4.5 (SD=2.1, median=4.0, range: 1-10). Total cautery time was significantly correlated with time to complete recovery (P<.05).

CONCLUSIONS

Intracapsular microdebrider tonsillectomy with adenoidectomy utilizing QuikClot to enhance the hemostasis results in recovery times better than previously reported for this common operation in children.