Effects of the Valsalva Maneuver on Intraoperative Bleeding During Tonsillectomy

Abstract

Objective: We investigated whether the Valsalva maneuver helps detect any further bleeding points following adequate hemostasis in tonsillectomy.

Methods: This was a prospective study of consecutive patients who underwent tonsillectomy performed in a tertiary medical center. The data collected included age, gender, method of operation, and hemorrhage (if any) informations. Immediately after completing the surgery, hemostasis was performed by an anesthesiologist using the Valsalva maneuver to identify bleeding points. Intraoperative and postoperative hemorrhage, as well as the treatment applied. were recorded.

Results: One hundred twenty patients underwent tonsillectomy (53 males and 67 females). Tonsillectomy was performed using cold dissection in 59 patients (26 males and 33 females) and bipolar diathermy in 61 patients (27 males and 34 females). The differences in intraoperative hemorrhage following Valsalva were significantly higher in the cold dissection group than in the hot (bipolar) group (p=0.044). Tonsillectomy using bipolar cautery had a statistically significantly higher postoperative hemorrhage rate than that using cold dissection (p<0.05).

Conclusion: The Valsalva maneuver is useful for identifying subtle bleeding vessels in tonsillectomy wound bed. We suggest applying the procedure for final verification of hemostasis before ending the surgery.