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Plasma Adrenaline Concentrations During Functional Endoscopic Sinus Surgery
Author(s) -
Anderhuber Wolfgang,
Walch Christian,
Nemeth Erika,
Semmelrock HansJürgen,
Berghold Andrea,
Ranftl Günther,
Stammberger Heinz
Publication year - 1999
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-199902000-00006
Subject(s) - functional endoscopic sinus surgery , medicine , anesthesia , epinephrine , blood pressure , lidocaine , catecholamine , intubation , surgery , sinusitis
Objectives/Hypothesis : Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. Study Design : In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. Methods : Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck‐Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. Results : In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) ( P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample ( P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery ( P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. Conclusions : Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline‐related side effects during FESS are extremely rare when the patient is monitored exactly.