title: Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery.
abstract: OBJECTIVE
  Neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to transsphenoidal surgeries. As there is a paucity of data comparing the effect of intramucosal nasal infiltration of different concentrations of adrenaline that is, 1:200,000 and 1:400,000 in patients undergoing transsphenoidal surgery, we conducted this study to evaluate the effect of these two concentrations of adrenaline with 2% lignocaine on hemodynamics as well as bleeding.
  
  
  METHODS
  Fifty-two American Society of Anesthesiologists I/II patients, aged 15-70 years, undergoing transsphenoidal surgery for pituitary or sellar masses were enrolled. Prior to surgical incision, nasal septal mucosa was infiltrated with lignocaine-adrenaline solution, after randomly allocating them to one of the two groups, with patients in Group A receiving intramucosal infiltration using 2% lignocaine with 1:200,000 adrenaline and those in Group B receiving 2% lignocaine with 1:400,000 adrenaline. Following infiltration, hemodynamic parameters were recorded every 1 min for 5 min and thereafter at every 5 min interval.
  
  
  RESULTS
  Fewer patients (3/24 [12.5%]) in Group B had a rise of >50% in systolic blood pressure, from baseline values, after nasal mucosa infiltration as compared with patients in Group A (9/24 [37.5%]). In addition, mean rise in systolic, diastolic and mean arterial pressure was also significantly lower in Group B as compared with Group A.
  
  
  CONCLUSIONS
  Adrenaline in a concentration of 1:400,000 added to 2% lignocaine for nasal mucosa infiltration produces less hemodynamic response as compared with adrenaline 1:200,000 added to 2% lignocaine while at the same time providing similar operating conditions.
authors.affiliation: Departments of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bhatia
authors.affiliation: Departments of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Babita
authors.initials: B
authors.lastname: Ghai
authors.affiliation: Departments of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Kishore
authors.initials: K
authors.lastname: Mangal
authors.affiliation: Departments of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Wig
authors.affiliation: Department of Neurosurgery, PGIMER, Chandigarh, India.
authors.forename: Kanchan K
authors.initials: KK
authors.lastname: Mukherjee
keywords: Hemodynamic effects; intramucosal infiltration; lignocaine-adrenaline infiltration; transsphenoidal surgery