Richard R Orlandi1, Smitha Warrier, Stephan Sato, Joseph K Han. 1. Division of Otolaryngology-Head and Neck Surgery, University of Utah, and Section of Otolaryngology-Head and Neck Surgery, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA. richard.orlandi@hsc.utah.edu
Abstract
BACKGROUND: The safety of topical epinephrine (1:1000 concentration) has recently been called into question. No objective data have been presented examining this issue. METHODS: We retrospectively reviewed all cases of endoscopic sinus surgery performed by the senior authors at their respective institutions. Perioperative records were reviewed for use of topical 1:1000 epinephrine and for any intraoperative or postoperative complications related to its use. RESULTS: During the study periods, 1998 cases of endoscopic sinus surgery were identified where topical 1:1000 epinephrine was used. Two complications were identified (0.1%), one at each institution. One patient suffered coronary artery vasospasm, attributed to the use of topical 1:1000 epinephrine during surgery. The other patient developed transient intraoperative hypertension immediately after inadvertent submucosal injection of concentrated epinephrine. This event was caused by an erroneous switch with the 1% lidocaine/1:100,000 solution. This error occurred early in the institution's experience with concentrated topical epinephrine. After implementation of additional preventative safeguards, no further errors or complications have occurred. CONCLUSION: Concentrated epinephrine has the potential for complications when used during endoscopic sinus surgery. Nevertheless, with appropriate safeguards described in this study, its topical use is safe.
BACKGROUND: The safety of topical epinephrine (1:1000 concentration) has recently been called into question. No objective data have been presented examining this issue. METHODS: We retrospectively reviewed all cases of endoscopic sinus surgery performed by the senior authors at their respective institutions. Perioperative records were reviewed for use of topical 1:1000 epinephrine and for any intraoperative or postoperative complications related to its use. RESULTS: During the study periods, 1998 cases of endoscopic sinus surgery were identified where topical 1:1000 epinephrine was used. Two complications were identified (0.1%), one at each institution. One patient suffered coronary artery vasospasm, attributed to the use of topical 1:1000 epinephrine during surgery. The other patient developed transient intraoperative hypertension immediately after inadvertent submucosal injection of concentrated epinephrine. This event was caused by an erroneous switch with the 1% lidocaine/1:100,000 solution. This error occurred early in the institution's experience with concentrated topical epinephrine. After implementation of additional preventative safeguards, no further errors or complications have occurred. CONCLUSION: Concentrated epinephrine has the potential for complications when used during endoscopic sinus surgery. Nevertheless, with appropriate safeguards described in this study, its topical use is safe.
Authors: Martin Hanson; Hao Li; Eliza Geer; Sasan Karimi; Viviane Tabar; Marc A Cohen Journal: World J Otorhinolaryngol Head Neck Surg Date: 2020-03-20
Authors: Or Kalchiem-Dekel; Aldo Iacono; Edward M Pickering; Ashutosh Sachdeva; Nirav G Shah; Mark Sperry; Bich-Chieu Tran; Robert M Reed Journal: BMJ Open Date: 2019-03-23 Impact factor: 2.692