Hemodynamic effects of locally applied epinephrine used with various general anesthetic techniques.
Halothane-nitrous oxide-oxygen (GOF), nitrous oxide-oxygen with diallyl-nor-toxiferine (Jackson-Rees method), or nitrous oxide-oxygen with droperidol-pentazocine (modified NLA) were administered in 190 instances of repair of cleft lips and cleft palates. Epinephrine, 1:30,000, 1:100,000, or 1:300,000, was injected as the vasoconstrictor around the operative field. Epinephrine concentration of 1:100,000 provided sufficient hemostasis, whereas 1:300,000 was insufficient. With the same concentration of epinephrine, GOF and modified NLA seemed to be better than the Jackson-Rees method, since the GOF and modified NLA groups showed less increase of pulse rate, blood pressure, and plethysmographic changes. A 1:30,000 concentration of epinephrine could be used safely with the Jackson-Rees method and the hemostasis with this concentration was superior to 1:100,000. However, it is recommended only for the cleft lip operation, since these patients are younger and need better hemostasis, and hypersalivation after reversal does not disturb the postoperative course. So-called epinephrine-induced arrhythmia with halothane anesthesia occurred in 1 of 34 instances with 1:300,000 solution and in 5 of 48 instances with 1:100,000 solution. Propranolol was given in only one instance. All others returned to normal rhythm with hyperventilation with pure oxygen. The use of 1:100,000 solution of epinephrine as an adjunct with modified NLA is the most satisfactory and safe method for cleft palate operations, and 1:30,000 with the Jackson-Rees is the better method for cleft lip repairs.
D000443:Alcuronium; D000704:Analysis of Variance; D000768:Anesthesia, General; D000777:Anesthetics / Q000494:pharmacology*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001285:Atropine; D001794:Blood Pressure / Q000187:drug effects; D002675:Child, Preschool; D003975:Diazepam; D004329:Droperidol; D004562:Electrocardiography; D004837:Epinephrine / Q000009:adverse effects / Q000494:pharmacology*; D006221:Halothane / Q000009:adverse effects; D006321:Heart / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006470:Hemorrhage / Q000209:etiology; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D007223:Infant; D009609:Nitrous Oxide; D010423:Pentazocine; D010991:Plethysmography; D011229:Preanesthetic Medication; D011674:Pulse / Q000187:drug effects
D000777:Anesthetics; D001285:Atropine; D009609:Nitrous Oxide; D004329:Droperidol; D003975:Diazepam; D010423:Pentazocine; D000443:Alcuronium; D006221:Halothane; D004837:Epinephrine