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Introduction Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery. Methods A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg. Results Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%. Conclusions Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial.

The views expressed in this paper are those of the author and do not necessarily represent CAA policy.The author would like to give grateful acknowledgement to the various companies from which information has been received. (Note that the original presentation at a RIN ordinary meeting was illustrated by numerous colour slides which cannot be reproduced here, as well as three video films).

Answers on p245. A 59 year old insulin dependent diabetic male presented with an eight week history of lower thoracic back pain and a two to three week history of progressive exertional dyspnoea, limiting his exercise tolerance to around 100 yards, associated with mild ankle oedema. He did not complain of cough or chest pain. He had been discharged from another hospital four weeks earlier after a prolonged admission with pneumonia and renal failure. There was no other past medical history of note. In particular, there …