title: Marked hypotension induced by adrenaline contained in local anesthetic.
abstract: OBJECTIVE
  Local anesthetics containing adrenaline, which often cause cardiovascular side effects, are routinely used in functional endoscopic sinus surgery (FESS) for the main purpose of hemostasis. The controversies concerning hemodynamic effects of adrenaline in local infiltration are widely discussed, but there is no definite conclusion. A prospective, randomized, double-blinded study was carried out to discover the hemodynamic effects after local infiltration of 1:200,000 adrenaline contained in 2% lidocaine under general anesthesia.
  
  
  METHODS
  Seventy-six adult patients undergoing FESS during general anesthesia were allocated randomly into three groups. Group I patients (n = 26) received 2% lidocaine 2 mL with adrenaline (1:200,000), group II patients (n = 25) received saline 2 mL with adrenaline (1:200,000), and group III patients (control group, n = 25) received saline 2 mL without adrenaline for local infiltration. Electrocardiogram (ECG) and heart rate (HR) were monitored simultaneously; systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were directly measured in radial artery continuously after local infiltration.
  
  
  METHODS
  SBP, DBP, MAP, and HR were recorded at 10 time points: before infiltration (baseline), 0.5 minutes, 1 minute, 1.5 minutes, 2 minutes, 2.5 minutes, 3 minutes, 3.5 minutes, 4 minute, and 5 minutes after infiltration.
  
  
  RESULTS
  Significant hemodynamic changes, particularly hypotension (P < .01), after local infiltration were observed in group I and group II compared with the baseline, but not in group III. However, there were no significant hemodynamic changes between group I and group II at the same time points (P > .05). The significant hemodynamic changes lasted no longer than 4 minutes.
  
  
  CONCLUSIONS
  Lidocaine (2%) or saline with adrenaline (1:200,000) does cause temporary hypotension and other hemodynamic changes during general anesthesia, which last no longer than 4 minutes. The causative mechanism is caused by the effect of adrenaline. This is a preliminary study.
authors.affiliation: Medical School of Nanjing University and Department of Anesthesiology, Jinling Hospital, Nanjing 210002, People's Republic of China.
authors.forename: J J
authors.initials: JJ
authors.lastname: Yang
authors.forename: Q P
authors.initials: QP
authors.lastname: Wang
authors.forename: T Y
authors.initials: TY
authors.lastname: Wang
authors.forename: J
authors.initials: J
authors.lastname: Sun
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: Zuo
authors.forename: J G
authors.initials: JG
authors.lastname: Xu
mesh_terms: D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000009:adverse effects* / Q000737:chemistry; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006488:Hemostasis, Surgical; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine