Effect of topical and subcutaneous epinephrine in combination with topicalthrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients
Jp. Barret et al., Effect of topical and subcutaneous epinephrine in combination with topicalthrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients, BURNS, 25(6), 1999, pp. 509-513
Bleeding is a major concern during burn wound excision. To evaluate the eff
icacy of epinephrine to control blood loss, a prospective cohort of 42 pedi
atric patients were examined. Half of the patients received topical epineph
rine to excised wounds and donor sites and subcutaneous epinephrine to scal
p donor sites during total burn excision, while the other half did not. Bot
h groups of patients received bovine topical thrombin sprayed at a concentr
ation of 1000 U/ml. Mean blood loss in the epinephrine group was 1090 ml (r
ange 20-4000), with a blood loss of 0.48 +/- 0.12 ml/cm(2) excised, while t
he control group was 1271 ml (range 40-3750) and 0.51 +/-0.15 ml/cm(2). Dif
ferences in preoperative and postoperative hematocrits were respectively -3
.4 +/- 7.8 and -4.6 +/- 7.5. The groups were not statistically different in
this analysis. Subgroup analysis by age, burn size and time of burn to exc
ision showed no differences. No complications or side effects of the use of
the vasopressor solution occurred. In conclusion, no differences in blood
loss were found between the groups. The routine use of local epinephrine du
ring total wound excision in combination with topical thrombin in pediatric
patients operated within 24 h after the admission may not be necessary. Th
e effect of topical thrombin on blood loss should be analyzed separately. (
C) 1999 Elsevier Science Ltd and ISBI. All rights reserved.