title: Staining intraoperative topical solutions with fluorescein: enhancing the safety of sinus surgery.
abstract: BACKGROUND
  Oxymetazoline HCl 0.05%, 1:100,000 lidocaine with epinephrine (lido+epi), and 1:1000 epinephrine are all colorless solutions employed in sinus surgery. Because lido+epi is injected whereas others are not, care must be taken to label all solutions to avoid inadvertent injection of oxymetazoline or concentrated epinephrine because of life-threatening complications. Dyes have been used to color solutions for visual identification, but efficacy and cost have never been compared. We sought to determine the effectiveness of surgical marking pen (gentian violet) and fluorescein strips as coloring agents in mediums commonly used in sinus surgery.
  
  
  METHODS
  In this specialty techniques study, 4 liquid mediums (normal saline [NS], 0.05% oxymetazoline, 1:1,000 epinephrine, and lido+epi) and 2 coloring agents (fluorescein strip and surgical marking pen) were combined separately. Photos and absorbance of each solution were obtained at 15-minute intervals over 2 hours using a spectrophotometer.
  
  
  RESULTS
  Peak absorbance remained stable for all solutions with fluorescein. Absorbance also remained constant for NS (0.37 absorbance units [AU] → 0.37 AU) and oxymetazoline (2.8 AU → 2.8 AU) mixed with marking pen. Absorbance decreased over 2 hours when marking pen was mixed with 1:1000 epinephrine (0.82 AU → 0.32 AU) and lido+epi (1.19 AU → 0.33 AU). Furthermore, the majority of color visibility and absorbance decreased in the first 15 minutes for concentrated epinephrine (0.82 → 0.33) and lido+epi (1.19 → 0.51). Cost of fluorescein strips ($0.14 to $0.20/strip) was less than marking pens ($13 to 46/pen).
  
  
  CONCLUSIONS
  Compared to marking pen dye, solutions dyed with fluorescein retained their color and did not decay over time. We recommend fluorescein strips to label colorless materials in the operating room because of their lack of color decay and cost advantages.
authors: Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: William C
authors: WC
authors: Yao
authors: Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: Rachel M
authors: RM
authors: Regone
authors: Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: Masayoshi
authors: M
authors: Takashima
mesh_terms: D004396:Coloring Agents; D019793:Fluorescein; D005840:Gentian Violet; D006801:Humans; D010256:Paranasal Sinuses / Q000601:surgery; D019999:Pharmaceutical Solutions; D013194:Staining and Labeling / Q000379:methods*
chemical_list: D004396:Coloring Agents; D019999:Pharmaceutical Solutions; D005840:Gentian Violet; D019793:Fluorescein
keywords: endoscopic sinus surgery; intraoperative sinus solutions; postoperative; safety; sinus surgery