title: The Pathophysiology of Early Hypotension Following Epinephrine-containing Local Anesthetic Infiltration of the Nasal Mucosa in Patients Undergoing Endoscopic Transsphenoidal Hypophysectomy: A Prospective, Observational Study.
abstract: In patients undergoing endoscopic transsphenoidal hypophysectomy, the nasal mucosa is often infiltrated with local anesthetic solutions that contain epinephrine to aid hemostasis. This may, however, result in hemodynamic changes, especially hypotension. We characterized the cardiovascular changes using a LiDCOrapid monitor in 13 patients after the infiltration of 4% articaine containing 1:200,000 epinephrine. Nine (69%) had a >20% decrease in mean arterial pressure at a median time of 116 seconds after the infiltration of articaine with epinephrine. Analysis of the cardiac output data revealed that this was caused by a sustained reduction in systemic vascular resistance. The arterial blood pressure normalized over a period of 60 to 90 seconds secondary to increases in stroke volume and heart rate producing an elevation in cardiac output. Transient hypotension following the infiltration of epinephrine-containing local anesthetics may be caused by epinephrine stimulation of β2-adrenoceptors producing vasodilation.
authors.affiliation: Departments of *Anaesthesia ‡Neurosurgery §Ear, Nose and Throat, Sheffield Teaching Hospital NHS Foundation Trust †University of Sheffield Medical School, Sheffield, UK.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Wiles
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Sanders
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sinha
authors.forename: Showkat
authors.initials: S
authors.lastname: Mirza
authors.forename: John C
authors.initials: JC
authors.lastname: Andrzejowski
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002355:Carticaine / Q000008:administration & dosage / Q000009:adverse effects; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects / Q000379:methods*; D007022:Hypotension / Q000139:chemically induced* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D009297:Nasal Mucosa; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002355:Carticaine; D004837:Epinephrine