A comparison of the efficacy of three different peak airway pressures on intraoperative bleeding point detection in patients undergoing thyroidectomy: a randomized, controlled, clinical trial

BACKGROUND: Various techniques are used to detect intraoperative bleeding points in thyroid surgery. We aimed to assess the effect of increasing peak airway pressure to 30, 40 and 50 cm H(2)O manually in detecting intraoperative bleeding points. METHODS: One hundred and 34 patients scheduled for total thyroidectomy were included to this prospective randomised controlled clinical study. We randomly assigned patients to increase peak airway pressure to 30, 40 and 50 cm H(2)O manually intraoperatively just before surgical closure during hemostasis control. The primary endpoint was the rate of bleeding points detected by the surgeon during peak airway pressure increase. RESULTS: The rate of detection of the bleeding points was higher in 50 cm H(2)O Group than the other two groups (15.9 vs 25.5 vs 40%, P = 0.030), after pressure administration, the HR, SpO(2), and P peak were similar between groups (P = 0.125, 0.196, 0.187, respectively). The median duration of the bleeding point detection after the pressure application was 21.82 s in 30 cm H(2)O, 25 s in 40 cm H(2)O, and 22.50 s in 50 cm H(2)O groups. Postoperative subcutaneous hematomas or hemorrhages requiring surgery were not seen in any patient. CONCLUSIONS: Manually increasing peak airway pressure to 50 cm H(2)O during at least 22.50 s may be used as an alternative way to detect intraoperative bleeding points in thyroid surgery. CLINICAL TRIAL REGISTRATION: NCT03547648. Registered 6 June2018