الفهرس 
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Abstract
This study was carried out to evaluate the effectiveness of topical tranexamic acid in reducing the post dental extraction bleeding as compared to intravenous tranexamic acid in paediatric dental extraction under general anaesthesia as regards the amount of bleeding and coagulation profile.
This study was done on eighty paediatric patients of both sexes, ASA I, aged from four to seven years old scheduled for dental extraction. They were randomly categorized into two equal groups (fourty each); group I received a loading dose 20 mg/kg and maintenance infusion dose 5 mg/kg/hour of intravenous tranexamic acid and group II received a 5% topical solution of tranexamic acid prepared by diluting 5 mL of TXA with 5 mL of normal saline added to 4x4 centimeters in size surgical swap and applied for five minutes duration after teeth extraction.
All patients were assessed pre-operatively by detailed history taking from parents, complete physical examination, and routine laboratory investigations. On arrival to the operating room, patients were connected to the standard monitoring; including electrocardiograph, non-invasive arterial blood pressure and pulse oximeter.
They were all subjected to the same anaesthetic protocol; they were pre-oxygenated with 100% oxygen for at least 3 minutes using a face mask. Induction of anaesthesia was started by the administration of fentanyl 1.5 µg/kg followed by lidocaine 1.5 mg/kg, then propfol 2 mg/kg intravenously. After the loss of verbal communication, 0.5 mg/kg atracurium was administrated then nasotracheal intubation was inserted.
Laboratory data measurements (haemoglobin, haematocrit, platelet count, PT, PTT and INR), blood volume loss measurements (the number of fully soaked swabs, blood volume in suction reservoir, time taken to complete stoppage of bleeding, and quality of surgical field), and surgeon’s satisfaction score were recorded and statistically analyzed.
By analyzing the laboratory data, in group I regarding the mean value of hemoglobin, the post-operative mean value (11.35±0.66 g/dl) was statistically significant lower than the preoperative mean value (11.49±0.93 g/dl) and in group II, the post-operative mean value (11.35±0.51 g/dl) was statistically significant lower than the preoperative mean value (11.45±0.67 g/dl) and according to the percentage of reduction of hemoglobin level, there was more reduction in hemoglobin level by (1.22%) in group I as compared to group II which was (0.87%). Also regarding the hematocrit level in group I, the post-operative mean value (32.33±1.58 %) was statistically significant lower than the preoperative mean value (34.15±2.39 %) and in group II, the post-operative mean value (32.45±1.36 %) was statistically significant lower than the preoperative mean value (33.83±1.95 %) and according to the percentage of reduction of hematocrit level, there was more reduction in the hematocrit level by (5.33%) in group I as compared to group II which was (4.08%). Regarding the platelet count and coagulation profile, there were no statistically significant differences between the preoperative and post-operative mean values in both groups. Also there were no statistically significant differences between both groups.
Blood volume loss was statistically significant lower in group II as compared to group I. Regarding the surgeon’s satisfaction score, had been found that most of the surgeons were more satisfied with better surgical field quality by (67.5%) in group II compared to group I (45%).