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Date Published: 09/10/2023
Online Published: 09/10/2023
Abstract Views: 1825
Views PDF: 1649
DOI: https://doi.org/10.60137/tmhvn.v68i61.65
Issue
Vol. 68 No. 61
Section
Articles
How to Cite
Vu, M. D., & Tran, V. L. (2023). The effectiveness and safety of local Adrenaline 1:1000 application in endoscopic sinus surgery. Vietnam Journal of Otorhinolaryngology - Head and Neck Surgery, 68(61), 58-66. https://doi.org/10.60137/tmhvn.v68i61.65

The effectiveness and safety of local Adrenaline 1:1000 application in endoscopic sinus surgery

Minh Duc Vu , Viet Luan Tran

Main Article Content

Abstract

Objective: Hemostasis during endoscopic sinus surgery is one of the critical factors, contributing the success of the surgery. Vasoconstrictor effect on the nasal mucosa by placing topical Adrenaline has been widely used in the world, but not in Viet Nam. Therefore, we conducted a study to evaluate the effectiveness and safety of local Adrenaline 1:1000 application in endoscopic sinus surgery. Patients and Methods: This is a case series study. Patients with chronic rhinosinusitis who underwent endoscopic sinus surgery under general anesthesia were included. The nasal cavities were packed with Adrenaline 1:1000-impregnated wicks for 5 minutes before starting the surgery. The volume of blood loss, Boezaart surgical field grading scale, heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded after general anesthesia before and after inserting the wicks at 1 minute, 3 minutes, 5 minutes, 10 minutes, and every 10 minutes until the surgery was finished. Results: 31 patients were included in the study. The average volume of blood loss was 377.41 ± 271.05 mL, and no cases of severe bleeding requiring blood transfusion were observed. Mild bleeding accounted for 77.5% of cases, while moderate bleeding accounted for 22.5% according to the Boezaart field grading scale. The heart rate increased by 1.97 ± 6.59 beats per minute after applying the wicks for 1 minute, slightly increased after 3 minutes and 5 minutes, and then decreased after 10 minutes and in the recovery room. No arrhythmia was noted. Systolic and diastolic blood pressure increased slightly after inserting the wicks for 1 minute and 3 minutes, but still remained within safe limits. No cardiovascular complications were observed during the surgery. Conclusion:  The application of topical Adrenaline 1:1000 is safe and effective in endoscopic sinus surgery. It helps to create a clear surgical field, reduces intra-operative bleeding, and does not significantly affect hemodynamics during the surgery.

Article Details

Keywords

Adrenalin, Hemostasis, Endoscopic sinus surgery

References

1. Ahmed, Omar G., et al. (2020), "Real-time hemodynamic effects of 1:100000 and 1:200000 injectable epinephrine and placement of topical 1:1000 epinephrine pledgets in patients undergoing endoscopic sinus and skull-base surgery: a randomized, prospective study.", International Forum of allergy & rhinology, pp. 141-146.
2. Boezaart, André P., Merwe, Johan van der, and Coetzee, André (1995), "Comparison of sodium nitroprusside and esmolol-induced controlled hypotension for functional endoscopic sinus surgery ", Can J Anaesth. 42, pp. 373-376.
3. Gunaratne, Dakshika A., et al. (2016), "Topical concentrated epinephrine (1:1000) does not cause acute cardiovascular changes during endoscopic sinus surgery", International Forum of Allergy & Rhinology. 6(2), pp. 135-39.
4. Hakan, Korkmaz, et al. (2015), "Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery", Int forum allergy rhinol. 15(5), pp. 1118-23
5. Krishnamurti Sarmento Junior, Shiro Tomita, and K., Arthur Octavio A. (2009), "Topical use of adrenaline in different concentrations for endoscopic sinus surgery ", Braz J Otorhinolaryngol. 75(2), pp. 280-89.
6. Kuan, Edward C., et al. (2018), "Is topical Epinephrine safe for hemostasis in endoscopic sinus surgery?", The Laryngoscope.
7. Lee, Ta-Jen, et al. (2009), "Hemostasis during functional endoscopic sinussurgery: The effect of local infiltration with adrenaline", Otolaryngology–Head and Neck Surgery. 140(2), pp. 209-214.
8. Moshaver, Ali, et al. (2009), "The Hemostatic and Hemodynamic Effects of Epinephrine During Endoscopic Sinus Surgery", ARCH OTOLARYNGOL HEAD NECK SURG. 135(2), pp. 1005-1009.
9. Orlandi, Richard R., et al. (2010), "Concentrated topical epinephrine is safe in endoscopic sinussurgery", American Journal of Rhinology & Allergy. 24(2), pp. 140-142.
10. P.J, Wormald (2007), "The surgical field in endoscopic sinus surgery", in E, Bumpert, Editor, Endoscopic sinus surgery: Anatomy, Three-dimensional Reconstruction and Surgical techniqe, Thieme, Newyork, pp. 89-93.
11. T.Yim, Michael, Ahmed, Omar G., and Takashima, Masayoshi (2017), "Evaluating real-time effects of topical 1:1000 epinephrine in endoscopicsinus and skull-base surgery on hemodynamic parameters throughintraoperative arterial line monitoring", International Forum of Allergy & Rhinology. 7, pp. 1065-69.
12. Timperley, Daniel, et al. (2010), "Perioperative and intraoperative maneuvers to optimize surgical outcomes in skull base surgery", Otolaryngol Clin N Am. 43, pp. 699-730.
13. Valdes, Constanza J., et al. (2014), "Topical cocaine vs adrenaline in endoscopic sinus surgery: a blindedrandomized controlled study", International Forum of Allergy & Rhinology. 4(8), pp. 646-650.
14. Wormald, Peter J., et al. (2005), "The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery", American Journal of Rhinology. 19, pp. 514-520.
15. Yang, J. J., et al. (2005), "Marked hypotension induced by adrenaline contained in local anesthetic", Laryngoscope. 115(2), pp. 348-52.
16. Zhao, Yi C. and Psaltic, Alkis J. (2016), "Hemostasis in sinus surgery", Current opinions otolaryngology heaa and neck surgery. 24(1), pp. 26-30.