Topical hemostatic agents in otolaryngologic surgery

Year 2010, Volume: 20 Issue: 2, 100 - 109, 20.03.2010

Baran Acar Mehmet Ali Babademez Hayriye Karabulut

Abstract

Topical hemostatic agents are largely used to reduce blood loss during otolaryngologic surgery. These agents play an important role in both keeping the patient’s hemodynamic equilibrium and allowing for a better view of the surgical field. These agents can be classified based on their mechanism of action, and include physical or mechanical agents. Most complications of topical hemostatic agents are sustained because of the antigenic reaction of those products. This paper reviews traditional and newer topical hemostatic agents with regard to their chemical properties, their mechanisms of action, and the benefits and complications of topical agents.

Keywords

Bleeding, local hemostasis, otolaryngologic surgery

Kulak burun boğaz ve baş boyun cerrahisinde topikal hemostatik ajanlar

Abstract

Topikal hemostatik ajanlar kulak burun boğaz ve baş boyun cerrahisinde kan kaybını azaltmak için yaygın olarak kullanılmaktadır. Bu ajanlar hem hastanın hemodinamisinin bozulmasını engel- ler hem de daha iyi cerrahi görüş alanı sağlar. Bu ajanlar etki mekanizmalarına göre fiziksel ve kimyasal ajanlar olarak sınıflanabilir. Topikal hemostatik ajanların en sık komplikasyonlarının bu ürünlerin antijenik reaksiyona neden olmaların- dan kaynaklandığı öne sürülmektedir. Bu yazıda geleneksel ve yeni topikal hemostatik ajanların kimyasal özellikleri, etki mekanizmaları, fayda ve yan etkileri derlenmiştir

Keywords

Kanama, lokal hemostaz, kulak burun boğaz ve baş boyun cerrahisi

References

• Zwischenberger JB, Brunston RL Jr, Swann JR, Conti VR. Comparison of two topical collagen-based hemo- static sponges during cardiothoracic procedures. J Invest Surg 1999;12:101-6.
• Tan SR, Tope WD. Effectiveness of microporous polysaccharide hemospheres for achieving hemosta- sis in mohs micrographic surgery. Dermatol Surg 2004;30:908-14.
• Levy JH. Hemostatic agents. Transfusion. 2004; 44(12 Suppl): 58-62.
• Landry JR, Kanat IO. Considerations in topical hemo- stasis. J Am Podiatr Med Assoc 1985;75:581-5.
• Arand AG, Sawaya R. Intraoperative chemical hemo- stasis in neurosurgery. Neurosurgery 1986;18:223-33.
• Wagner WR, Pachence JM, Ristich J, Johnson PC. Comparative in vitro analysis of topical hemostatic agents. J Surg Res 1996;66:100-8.
• Cushing H. Electrosurgery as an aid to the removal of intracranial tumors: with a preliminary note on a new surgical-current generator by W T Bovie. Surg Gynecol Obstet 1928;47:751-84.
• Tan TC, Black PM. Sir Victor Horsley (1857-1916): pioneer of neurological surgery. Neurosurgery 2002; 50:607-11.
• Stone JL. Sir Charles Ballance: pioneer British neuro- logical surgeon. Neurosurgery 1999;44:610-31.
• Tomizawa Y. Clinical benefits and risk analysis of topi- cal hemostats: a review. J Artif Organs 2005;8:137-42.
• Hait MR. Microcrystalline collagen. A new hemostatic agent. Am J Surg 1970;120:330.
• Low WK, Sim CS. Bone wax foreign body granuloma in the mastoid. ORL J Otorhinolaryngol Relat Spec 2002;64:38-40.
• Allison RT. Foreign body reactions and an associated histological artefact due to bone wax. Br J Biomed Sci 1994;51:14-7.
• Howard TC, Kelley RR. The effect of bone wax on the healing of experimental rat tibial lesions. Clin Orthop Relat Res 1969;63:226-32.
• Patel PM, Blackburn TP, Chitnavis BP. Syringe tip accuracy for application of Victor Horsley’s bone wax. Br J Neurosurg 2003;17:546.
• Hadeishi H, Yasui N, Suzuki A. Mastoid canal and migrated bone wax in the sigmoid sinus: technical report. Neurosurgery 1995;36:1220-3.
• Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J 2005;81:309-14.
• Palm MD, Altman JS. Topical hemostatic agents: a review. Dermatol Surg 2008;34:431-45.
• Murthy P, Laing MR. An unusual, severe adverse reaction to silver nitrate cautery for epistaxis in an immunocompromised patient. Rhinoloy 1996;34:186-7.
• Mayall F, Wild D. A silver tattoo of the nasal mucosa after silver nitrate cautery. J Laryngol Otol 1996; 110:609-10.
• Larson PO. Topical hemostatic agents for dermatologic surgery. J Dermatol Surg Oncol 1988;14:623-32.
• Link TR, Conley SF, Flanary V, Kerschner JE. Bilateral epistaxis in children: efficacy of bilateral septal cauterization with silver nitrate. Int J Pediatr Otorhinolaryngol 2006;70:1439-42.
• Hajek M. Indikation der verschiedenen Behandlungs- und Operationsmethoden bei den entzündlichen Erkrankungen der Nebenhöhlen der Nase. Z Hals Nasen Ohrenheilkunde 1922;4:511-22
• Halle M. Nasennebenhöhlenoperationen. Z Hals Nasen Ohrenheilkunde 1923;4:489-510.
• Long H, Greller H, Mercurio-Zappala M, Nelson LS, Hoffman RS. Medicinal use of cocaine: a shifting para- digm over 25 years. Laryngoscope 2004;114:1625-9.
• Kennedy DW, Zinreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery. Theory and diag- nostic evaluation. Arch Otolaryngol 1985;111:576-82.
• Thaler ER, Gottschalk A, Samaranayake R, Lanza DC, Kennedy DW. Anesthesia in endoscopic sinus surgery. Am J Rhinol 1997;11:409-13.
• De R, Uppal HS, Shehab ZP, Hilger AW, Wilson PS, Courteney-Harris R. Current practices of cocaine administration by UK otorhinolaryngologists. J Laryngol Otol 2003;117:109-12.
• Stark TW, Pruet CW, Stark DU. Cocaine toxicity. Ear Nose Throat J 1983;62:155-8.
• Light RU, Prentice HR. Surgical investigation of a new absorbable sponge derived from gelatin for use in hemostasis. J Neurosurg 1945;2:435-45.
• Gall RM, Witterick IJ, Shargill NS, Hawke M. Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent. J Otolaryngol 2002;31:271-4.
• Hellström S, Salén B, Stenfors LE. Absorbable gela- tin sponge (Gelfoam) in otosurgery: one cause of undesirable postoperative results? Acta Otolaryngol 1983;96:269-75.
• Oz MC, Cosgrove DM 3rd, Badduke BR, Hill JD, Flannery MR, Palumbo R, et al. Controlled clinical trial of a novel hemostatic agent in cardiac surgery. The Fusion Matrix Study Group. Ann Thorac Surg 2000;69:1376-82.
• Ellegala DB, Maartens NF, Laws ER Jr. Use of FloSeal hemostatic sealant in transsphenoidal pituitary sur- gery: technical note. Neurosurgery 2002;51:513-5.
• Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostat- ic sealant in patients with acute anterior epistaxis. Laryngoscope 2005;115:899-902.
• Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostat- ic sealant in children undergoing adenoidectomy. Otolaryngol Head Neck Surg 2004;131:601-5.
• Jo SH, Mathiasen RA, Gurushanthaiah D. Prospective, randomized, controlled trial of a hemostatic sealant in children undergoing adenotonsillectomy. Otolaryngol Head Neck Surg 2007;137:454-8.
• Chandra RK, Conley DB, Haines GK 3rd, Kern RC. Long-term effects of FloSeal packing after endoscopic sinus surgery. Am J Rhinol 2005;19:240-3.
• Jameson M, Gross CW, Kountakis SE. FloSeal use in endoscopic sinus surgery: effect on postoperative bleeding and synechiae formation. Am J Otolaryngol 2006;27:86-90.
• Winterbottom N, Kuo JM, Guyen KN, et al. Antigenic responses to bovine thrombin exposure during sur- gery: a prospective study of 309 patients. J Appl Res Clin Exp Ther 2002;2:23-9.
• Landry JR, Kanat IO. Considerations in topical hemo- stasis. J Am Podiatr Med Assoc 1985;75:581–5.
• Levy S, Brodsky L, Stanievich J. Hemorrhagic tonsil- litis. Laryngoscope 1989;99:15-8.
• Walike JW, Chinn J. Evaluation and treatment of acute bleeding from the head and neck. Otolaryngol Clin North Am 1979;12:455-64.
• Liening DA, Lundy L, Silberberg B, Finstuen K. A comparison of the biocompatibility of three absorbable hemostatic agents in the rat middle ear. Otolaryngol Head Neck Surg 1997;116:454-7.
• Alpaslan C, Alpaslan GH, Oygur T. Tissue reaction to three subcutaneously implanted local hemostatic agents. Br J Oral Maxillofac Surg 1997;35:129-32.
• Alexander JM, Rabinowitz JL. Microfibrillar collagen (Avitene) as a hemostatic agent in experimental oral wounds. J Oral Surg 1978;36:202-5.
• Savva A, Taylor MJ, Beatty CW. Management of cere- brospinal fluid leaks involving the temporal bone: report on 92 patients. Laryngoscope 2003;113:50-6.
• Maxwell JA, Goldware SI. Use of tissue adhesive in the surgical treatment of cerebrospinal fluid leaks. Experience with isobutyl 2-cyanoacrylate in 12 cases. J Neurosurg 1973;39:332-6.
• Wiseman DM, Kamp LF, Saferstein L, Linsky CB, Gottlick LE, Diamond MP. Improving the efficacy of INTERCEED Barrier in the presence of blood using thrombin, heparin or a blood insensitive bar- rier, modified INTERCEED (nTC7). Prog Clin Biol Res 1993;381:205-12.
• Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S. In vitro antimicrobial activity of oxi- dized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect (Larchmt) 2003;4:255-62.
• Mannucci PM. Hemostatic drugs. N Engl J Med 1998;339:245-53.
• Oztürkcan S, Katilmiş H, Ozkul Y, Erdoğan N, Başoğlu S, Tayfun MA. Surgical treatment of the high jugular bulb by compressing sinus sigmoideus: two cases. Eur Arch Otorhinolaryngol 2008;265:987-91.
• Karkos PD, Thinakararajan T, Goodyear P, Srinivasan VR. Day-case endoscopic sinus surgery using dissolv- able haemostatic nasal packs: a pilot study. Eur Arch Otorhinolaryngol 2007;264:1171-4.
• Shinkwin CA, Beasley N, Simo R, Rushton L, Jones NS. Evaluation of Surgicel Nu-knit, Merocel and Vasolene gauze nasal packs: a randomized trial. Rhinology 1996;34:41-3.
• Gao HW, Lin CK, Yu CP, Yu MS, Chen A. Oxidized cellulose (Surgicel) granuloma mimicking a primary ovarian tumor. Int J Gynecol Pathol 2002;21:422-3.
• Bergel S. Über Wirkungen des Fibrins. Dtsch Med Wochenschr. 1909;35:633-65.
• Harvey SC. Hemostatic in parenchymatous organs. Boston Med Surg J. 1916;174:659–62.
• Staindl O. Tissue adhesion with highly concentrated human fibrinogen in otolaryngology. Ann Otol Rhinol Laryngol 1979;88:413-8.
• Lyons MB, Lyons GD, Webster D, Wheeler VR. Adhesives in larynx repair. Laryngoscope 1989;99:376-81.
• Epstein GH, Weisman RA, Zwillenberg S, Schreiber AD. A new autologous fibrinogen-based adhesive for oto- logic surgery. Ann Otol Rhinol Laryngol 1986;95:40-5.
• Portmann M. Results of middle ear reconstruction surgery. Ann Acad Med Singapore 1991;20:610-3.
• Park MS. Autologous fibrin glue for tympanoplasty. Am J Otol 1994;15:687-9.
• Moralee SJ, Carney AS, Cash MP, Murray JA. The effect of fibrin sealant haemostasis on post-operative pain in tonsillectomy. Clin Otolaryngol Allied Sci 1994; 19:526-8.
• Wax MK, Ramadan HH, Ortiz O, Wetmore SJ. Contemporary management of cerebrospinal fluid rhi- norrhea. Otolaryngol Head Neck Surg 1997;116:442-9.
• D’Arrigo C, Landolt AM. Fibrin sealing of mucoper- ichondrial flaps in endonasal-transsphenoidal pituitary surgery: technical note. Neurosurgery 1994;35:529-31.
• Vaiman M, Segal S, Eviatar E. Fibrin glue treatment for epistaxis. Rhinology 2002;40:88-91.
• Richmon JD, Tian Y, Husseman J, Davidson TM. Use of a sprayed fibrin hemostatic sealant after laser therapy for hereditary hemorrhagic telangiectasia epistaxis. Am J Rhinol 2007;21:187-91.
• Vaiman M, Eviatar E, Segal S. The use of fibrin glue as hemostatic in endonasal operations: a prospective, randomized study. Rhinology 2002;40:185-8.
• Vaiman M, Eviatar E, Segal S. Effectiveness of sec- ond-generation fibrin glue in endonasal operations. Otolaryngol Head Neck Surg 2002;126:388-91.
• Vaiman M, Eviatar E, Shlamkovich N, Segal S. Effect of modern fibrin glue on bleeding after tonsillec- tomy and adenoidectomy. Ann Otol Rhinol Laryngol 2003;112:410-4.
• Segal N, Puterman M, Rotem E, Niv A, Kaplan D, Kraus M, et al. A prospective randomized double- blind trial of fibrin glue for reducing pain and bleed- ing after tonsillectomy. Int J Pediatr Otorhinolaryngol 2008;72:469-73.
• Stoeckli SJ, Moe KS, Huber A, Schmid S. A prospec- tive randomized double-blind trial of fibrin glue for pain and bleeding after tonsillectomy. Laryngoscope 1999;109:652-5.
• Fattahi T, Mohan M, Caldwell GT. Clinical applications of fibrin sealants. J Oral Maxillofac Surg 2004;62:218-24.
• Nelson PA, Powers JN, Estridge TD, Elder EA, Alea AD, Sidhu PK, et al. Serological analysis of patients treated with a new surgical hemostat containing bovine proteins and autologous plasma. J Biomed Mater Res 2001;58:710-9.
• Bänninger H, Hardegger T, Tobler A, Barth A, Schüpbach P, Reinhart W, et al. Fibrin glue in sur- gery: frequent development of inhibitors of bovine thrombin and human factor V. Br J Haematol 1993; 85:528-32.
• Poynton AR, Nelson MC, McCance SE, Levine RL, O’Leary PF. Bovine thrombin induces an acquired coagulopathy in sensitized patients undergoing revi- sion spinal surgery: a report of two cases. Spine (Phila Pa 1976) 2003;28:E221-3.
• Thorisdottir H, Ratnoff OD, Maniglia AJ. Activation of Hageman factor (factor XII) by bismuth subgallate, a hemostatic agent. J Lab Clin Med 1988;112:481-6.
• Maniglia AJ, Kushner H, Cozzi L. Adenotonsillectomy. A safe outpatient procedure. Arch Otolaryngol Head Neck Surg 1989;115:92-4.
• Fenton JE, Blayney AW, O’Dwyer TP. Bismuth sub- gallate-its role in tonsillectomy. J Laryngol Otol 1995;109:203-5.
• Wormald PJ, Sellars SL. Bismuth subgallate: a safe means to a faster adenotonsillectomy. J Laryngol Otol 1994;108:761-2.
• Callanan V, Curran AJ, Smyth DA, Gormley PK. The influence of bismuth subgallate and adrenaline paste upon operating time and operative blood loss in ton- sillectomy. J Laryngol Otol 1995;109:206-8.
• Hatton RC. Bismuth subgallate-epinephrine paste in adenotonsillectomies. Ann Pharmacother 2000;34:522-5.
• Sİrensen WT, Henrichsen J, Bonding P. Does bismuth subgallate have haemostatic effects in tonsillectomy? Clin Otolaryngol Allied Sci 1999;24:72-4.
• Cozzi LM, Megerian CA, Dugue C, Barcello M, Abdul- Karim FW, Arnold JE, et al. Pulmonary sequelae of intraparenchymal bismuth subgallate. Laryngoscope 1992;102:597-9.
• Murray AD, Gibbs SR, Billings KR, Biavati MJ. Respiratory difficulty following bismuth subgal- late aspiration. Arch Otolaryngol Head Neck Surg 2000;126:79-81.
• Glick R, Green D, Ts’ao C, Witt WA, Yu AT, Raimondi AJ. High does epsilon-aminocaproic acid prolongs the bleeding time and increases rebleeding and intraop- erative hemorrhage in patients with subarachnoid hemorrhage. Neurosurgery 1981;9:398-401.
• Falbe-Hansen J Jr, Jacobsen B, Lorenzen E. Local application of an antifibrinolytic in tonsillectomy. A double-blind study. J Laryngol Otol 1974;88:565-8.
• Radziev MK. Local use of epsilon-aminocaproic acid in tonsillectomy. Vestn Otorinolaringol 1974;3:92-3. [Abstract]
• Thomas DC, Wormald PJ. A randomized controlled pilot study of epsilon-aminocaproic acid as a topi- cal hemostatic agent for postoperative bleeding in the sheep model of chronic sinusitis. Am J Rhinol 2008;22:188-91.
• Athanasiadis T, Beule AG, Wormald PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol 2007;21:737-42.
• Overbosch HC, Hart HC. Local application of epsilon- aminocaproic acid (E.A.C.A.) in the prevention of haemorrhage after tonsillectomy. J Laryngol Otol 1970;84:905-8.
• Azzena B, Mazzoleni F, Abatangelo G, Zavan B, Vindigni V. Autologous platelet-rich plasma as an adi- pocyte in vivo delivery system: case report. Aesthetic Plast Surg 2008;32:155-8.
• Pomerantz J, Dutton JM. Platelet gel for endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2005;114: 699-704.