title: The effect of clysed and topical epinephrine on intraoperative catecholamine levels.
abstract: BACKGROUND
  Epinephrine administration for hemostasis during burn wound excision may produce potential anesthetic risks. Two patient groups were studied to determine the absorption of either topical concentrated epinephrine or exogenously injected dilute epinephrine.
  
  
  METHODS
  For the topical group (10 patients, 10 procedures), excision of wounds under tourniquet was performed, followed by epinephrine (1 mg/10 mL) gauze with pressure wrapping. For the clysis group (9 patients, 12 procedures), donor sites were injected with 0.5 mg epinephrine/1,000 mL lactated Ringer's solution before harvest. Nine intraoperative serum samples were collected and frozen during each procedure for epinephrine and norepinephrine assay.
  
  
  RESULTS
  Concentrated epinephrine (67 mL) was topically applied to excise 1,362 cm2. Dilute epinephrine (1,350 mL) was clysed to obtain 1,950 cm2 autograft. No significant increases in the serum catecholamines or changes in the cardiovascular profiles occurred.
  
  
  CONCLUSIONS
  The administration of either topical or clysed epinephrine during acute burn excision does not cause any side effects for safe anesthetic management; there were no detectable increased plasma levels of epinephrine or norepinephrine. Epinephrine provides the burn surgeon with two safe methods for controlling intraoperative blood loss.
authors.affiliation: Department of Surgery, University of California Davis Medical Center, Sacramento, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Missavage
authors.forename: R L
authors.initials: RL
authors.lastname: Bush
authors.forename: N D
authors.initials: ND
authors.lastname: Kien
authors.forename: D A
authors.initials: DA
authors.lastname: Reilly
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002056:Burns / Q000601:surgery*; D004837:Epinephrine / Q000008:administration & dosage* / Q000097:blood*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000097:blood*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine; D004837:Epinephrine