title: Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery.
abstract: BACKGROUND
  Effective topical decongestion is critical for the safe performance of endoscopic endonasal surgery (EES). Despite the vasoconstriction offered by topical concentrated (1:1000) epinephrine (CE), its use has not gained widespread acceptance because of concerns over systemic absorption and its effect on blood pressure and postoperative rebound epistaxis. The purpose of this study was to examine the physiological changes in blood pressure and rate of epistaxis with use of topical CE in a variety of endoscopic nasal procedures.
  
  
  METHODS
  EES procedures using inhalational anesthesia and topical CE performed on 1140 consecutive patients (14 patients under 18 years) between 2011 and 2014 were evaluated retrospectively. Demographic data, intraoperative hemodynamic parameters, and postoperative epistaxis rates were recorded.
  
  
  RESULTS
  The mean patient age was 45.8 years (range, 5-97 years). No intraoperative cardiovascular complications related to CE use were found. Four patients (0.35%) developed postoperative epistaxis requiring intervention. The mean estimated blood loss among patients undergoing bilateral sinus surgery, skull-base surgery, and orbital decompression was (mean ± SD) 61.7 ± 51.6 mL, 60.1 ± 115 mL, and 67.9 ± 42.2 mL, respectively. The maximum mean systolic blood pressure among these groups was 108.3 ± 28.3 mmHg, 111.9 ± 27.6 mmHg, and 95.1 ± 31.7 mmHg, respectively.
  
  
  CONCLUSIONS
  The use of topical CE is safe when performing endoscopic endonasal procedures. CE was not associated with any intraoperative complications. The profound intraoperative vasoconstriction does not confer a higher rate of postoperative rebound epistaxis.
authors.affiliation: Otorhinolaryngology Department, Faculty of Medicine, Ordu University, Ordu, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Korkmaz
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: William C
authors.initials: WC
authors.lastname: Yao
authors.affiliation: Otorhinolaryngology Department, Faculty of Medicine, Ordu University, Ordu, Turkey.
authors.forename: Mukadder
authors.initials: M
authors.lastname: Korkmaz
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014663:Nasal Decongestants / Q000008:administration & dosage* / Q000009:adverse effects; D010256:Paranasal Sinuses / Q000187:drug effects* / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D014663:Nasal Decongestants; D004837:Epinephrine
keywords: concentrated epinephrine; endoscopic sinus surgery; intraoperative bleeding; postoperative epistaxis; vasoconstriction