The Hemostatic Efficacy of Hydrogen Peroxide Irrigation to Control Intraoperative Bleeding in Adenoidectomy

Efficacy of Continuous Suctioning in Adenoidectomy Haemostasis-Clinical Study

Introduction: Adenoidectomy is often the first major surgical challenge for the child's haemostatic system, and controlling intraoperative bleeding can be a challenge for the surgeon. Different methods have been used intraoperatively by surgeons in order to enhance haemostasis. The cold air effect (continuous suctioning) has been used by some surgeons during adenoidectomy; however, no documentation of its haemostatic effect has been made. Objectives: Our prospective randomised controlled study enrolled a sample of 140 children undergoing adenoidectomy, and we studied the effect of continuous suctioning on the duration of haemostasis in paediatric adenoidectomy. Materials and Methods: We evaluated the effect of using continuous suctioning during haemostasis at the end of adenoidectomy procedures, comparing variables such as total surgery time, total haemostasis time, and intraoperative blood loss, between two groups: 70 adenoidectomy procedures where no continuous suctioning was used to enhance haemostasis versus the other 70 patients where continuous suctioning was the haemostatic method employed. RESULTS: After statistical analysis of the recorded data, we found that the total duration of adenoidectomy, the duration of haemostasis in adenoidectomy, and the intraoperative blood loss were significantly lower in patients in whom cold air was used for haemostasis. Intraoperative haemostasis failure (and consequent use of electrocautery for haemostasis) was more frequent in patients in whom no suctioning was used; as for the rates of postoperative primary bleeding after adenoidectomy, they were similar in both groups of patients, regardless of the technique used for haemostasis. Conclusions: The use of continuous suctioning during adenoidectomy haemostasis significantly shortens total surgical and haemostasis time, reduces intraoperative blood loss, and reduces the incidence of haemostasis failure (with the consequent need for bipolar electrocautery haemostasis).

Alkaline hydrogen peroxide solutions: expectorant, pyolytic, mucolytic, haemolytic, oxygen-releasing, and decolorizing effects

The local action of hydrogen peroxide solutions on such dense biological masses, such as pus, mucus, sputum, and blood clots, is influenced not only by the concentration of the hydrogen peroxide but also by the alkalinity of the solution and the temperature of the interaction medium. Increasing the solutions temperature from 24C26C to 45C55C and its alkalinity from pH 7.0 to 8.48.5 enhances the pyolytic, mucolytic, hemolytic, bleaching, and oxygen-releasing activity of hydrogen peroxide solutions. Simple heating achieves the desired level of hyperthermia, while the addition of sodium bicarbonate provides the indicated alkalinity. Hyperthermia, according to the laws of physics, reduces the viscosity of biological masses, increasing their fluidity, permeability to the antiseptic solution, miscibility, and solubility in it. Furthermore, hyperthermia accelerates the rate of chemical, physicochemical, and biochemical processes, according to the Arrhenius law. The elevated temperature of interacting media speeds up the alkaline saponification process of proteins and protein-lipid complexes, which constitute the colloidal basis of biological masses. Additionally, hyperthermia intensifies the enzymatic decomposition of hydrogen peroxide into water and oxygen gas, facilitated by the enzyme catalase present in most biological masses. The released molecular oxygen generates gas bubbles that mimic cold boiling, leading to the explosion of biological masses, transforming them into a fluffy white foam. Oxygen in an alkaline environment oxidizes biological pigments, including hemoglobin and its metabolites of different colors, resulting in their discoloration.

Use and Abuse of Electrocautery in Adenoidectomy Hemostasis

Background and objectives: Bipolar electrocautery is commonly used to control bleeding after cold-instrument pediatric adenoidectomy, but the surgeon should be aware of the possible side effects. OBJECTIVE: The aim of our study is to investigate the effects of bipolar electrocautery when used for bleeding control at the end of an adenoidectomy procedure. Materials and Methods: We evaluated the effect of electrocautery on postoperative pain, velopharyngeal insufficiency symptoms, postoperative nasal obstruction, and rhinorrhea in a group of 90 children undergoing adenoidectomy in our ENT department over a period of 3 months. Results: After statistically analyzing the data, we found that the duration of postoperative pain, the duration of rhinorrhea and nasal obstruction, and the duration of painkiller administration, as well as the velopharyngeal insufficiency symptoms, were significantly longer in patients in whom electrocautery was used for hemostasis. A significantly higher incidence of posterior neck pain and halitosis (oral malodor) was noted in the patients in whom electrocautery was used for adenoidectomy hemostasis. Conclusions: Bipolar electrocautery use should be limited during pediatric adenoidectomy hemostasis because of the possible side effects: longer postoperative pain, prolonged nasal obstruction, rhinorrhea and velopharyngeal insufficiency, and halitosis. We noted some side effects that were specific to electrocautery use during adenoidectomy: posterior neck pain and oral malodor. Acknowledging the risk for these symptoms can help to alleviate the anxiety of both the parents and the patients regarding the expected postoperative outcomes.

What is the most appropriate hemostatic material during pediatric adenoidectomy? A prospective comparative randomized double-blinded controlled study

OBJECTIVES

To evaluate the effect of different hemostatic materials used in adenoidectomy operations to improve the quality of life with the most negligible hazardous impact on pediatric health.

STUDY DESIGN

a prospective, case-series, randomized, controlled, double-blinded study.

SETTING

All adenoidectomy surgeries were performed between September 2016 to December 2019 at tertiary referral institutions.

PATIENTS AND METHODS

519 patients were included in five groups. Adenoidectomy was performed under general anesthesia, with the following hemostatic procedures: adrenaline, tranexamic acid, hydrogen peroxide, xylometazoline, and saline (as a control group). The five groups were compared regarding the intraoperative blood loss, surgery duration, need for more hemostatic steps, postoperative reactionary and secondary bleedings, postoperative pain and halitosis, and one-year outcome.

RESULTS

The four procedures were effective in reducing the blood loss by 19.86%, 11.7%, 30.95%, and 18.91%, respectively, in comparison to the control group. The surgical duration was reduced by 27.65%, 17.86%, 48.11%, and 23.88%, respectively. The need for other hemostatic steps was the least in the hydrogen peroxide group. There was no significant difference between the five groups regarding reactionary bleeding, secondary bleeding, one-week pain, one-month pain, one-month halitosis, and one-year complications. On the other side, hydrogen peroxide had the least one-week halitosis and first-day pain among the five groups. Also, it had the least intraoperative blood loss and surgery duration.

CONCLUSIONS

Hydrogen peroxide showed to be the best choice to control hemostasis during an adenoidectomy. It can decrease blood loss and surgery duration with less need for other hemostatic steps. It can improve the patient's quality of life without significant postoperative complications. Xylometazoline was studied for the first time as a hemostatic material during adenoidectomy with good satisfying results.

Origin and Use of Hydrogen Peroxide in Neurosurgery

Hydrogen peroxide (H2O2) is a chemical with a wide range of applications. This includes its use in the medical field, in which its use has been ubiquitous but is most useful as an antiseptic and in achieving hemostasis. Neurosurgeons have been using H2O2 for well over a century, primarily for its hemostatic and antiseptic effects. This is in spite of the fact that the actual effectiveness of H2O2 as an antiseptic is questionable, and its use, in general, may be more dangerous than it appears. We review the application of H2O2 in medicine generally and, more specifically, in neurosurgery. This review outlines the reasoning behind the use of H2O2 as an antiseptic and details why it may not be as effective as one might think. We also detail its use as a hemostatic agent in neurosurgery, reviewing a number of techniques in which it has been useful in this role. Finally, we review the documented cases of complications associated with the use of H2O2 in neurosurgery. Ultimately, we conclude that the use of H2O2 in neurosurgery be reconsidered because of its lack of effectiveness as an antiseptic and potentially fatal complications.

[Effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery]

Objective

To investigate the effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery.

Methods

A clinical data of 510 patients with multi-segmental lumbar degenerative diseases who were treated with surgery between January 2017 and January 2018 was retrospectively analyzed. In study group, the incisions of 230 cases were washed with hydrogen peroxide before suture. In control group, the incisions of 280 cases were washed with normal saline before suture. There was no significant difference in gender, age, lesion type, disease duration, operative segment, and other clinical data between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and postoperative incidence of infection were recorded and compared between the two groups. The Centers for Disease Control and Prevention (CDC) standard was used to evaluate infection, which was divided into superficial infection and deep infection.

Results

All operations completed successfully. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). The postoperative drainage volume in the study group was significantly less than that in the control group ( t=-2.990, P=0.005). A total of 13 patients developed infection after operation, including 10 cases of superficial infection (2 cases in the study group and 8 cases in the control group) with the infection time of (7.3±1.5) days, and 3 cases of deep infection (all in the control group) with the infection time of (16.6±3.1) days. The incidences of superficial and deep infections in the study group were lower than those in the control group, but there was no significant difference between the two groups ( χ ²=2.595, P=0.123; P=0.256). All the superficial infections were Staphylococcus aureus infection and recovered after active dressing change. Among the patients with deep infections, 2 cases were infected by Staphylococcus aureus and 1 case was infected by Escherichia coli; and the incisions healed after being washed and sutured thoroughly, and active dressing change.

Conclusion

The incidence of postoperative infection and postoperative drainage volume can be reduced by washing the incision with hydrogen peroxide in multi-segmental lumbar surgery.

Oxygen Embolism and Pneumocephalus After Hydrogen Peroxide Application During Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Case Report and Literature Review

BACKGROUND

Hydrogen peroxide (H₂O₂) solution is commonly used to irrigate wounds because of its hemostatic and antiseptic properties. Previous studies suggest that H₂O₂ can result in toxicity to keratinocytes and fibroblasts, but complications after H₂O₂ application, including oxygen embolism, which is one of the most severe, have rarely been reported.

CASE DESCRIPTION

A 40-year-old woman was diagnosed with L4-5 lumbar spinal stenosis and subsequently underwent minimally invasive transforaminal lumbar interbody fusion treatment at another hospital. Hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occurred immediately after H₂O₂ irrigation. After the operation, she was able to be extubated but remained comatose. Postoperative computed tomography scan revealed intracranial air trapping in the right frontal lobe and multiple cerebral infarction foci.

CONCLUSIONS

When using a knee-prone surgical position or in cases of dural laceration, the application of undiluted H₂O₂ solution should be avoided, especially in a surgical wound within a closed cavity. When hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occur immediately after H₂O₂ irrigation, oxygen embolism should be strongly suspected.