Plasma adrenaline concentrations during functional endoscopic sinus surgery.
OBJECTIVE
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.


METHODS
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.
Anderhuber
W
W
Department of General Otorhinolaryngology, University Hospital Graz, Austria.
Walch
C
C
Nemeth
E
E
Semmelrock
H J
HJ
Berghold
A
A
Ranftl
G
G
Stammberger
H
H
D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000378:metabolism; D002851:Chromatography, High Pressure Liquid; D004562:Electrocardiography; D004724:Endoscopy / Q000379:methods*; D004837:Epinephrine / Q000097:blood* / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009297:Nasal Mucosa / Q000187:drug effects; D010256:Paranasal Sinuses / Q000601:surgery*; D011446:Prospective Studies; D014068:Tonsillectomy / Q000379:methods; D014662:Vasoconstrictor Agents / Q000097:blood* / Q000494:pharmacology*
D002395:Catecholamines; D014662:Vasoconstrictor Agents; D004837:Epinephrine