Zhao Feng, Wang Zhongyun, Yang Jianjun, Sun Jie, Wang Qiuping, Xu Jianguo
Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, P.R. China.
Am J Rhinol. 2006 Mar-Apr;20(2):182-5.
Low-dosage adrenaline contained in local anesthetics is commonly used for hemostasis during functional endoscopic sinus surgery (FESS), but often causes significant hemodynamic side effects that might be neglected. A randomized, controlled, prospective clinical trial was designed to find out these effects after local infiltration of different concentrations and/or different dosages of adrenaline during FESS under general anesthesia.
One hundred eight adult patients were randomized into one of four groups to receive 2 mL of 2% lidocaine and adrenaline 1:200,000 (group I), 4 mL of 1% lidocaine and adrenaline 1:400,000 (group II), 4 mL of 1% lidocaine and adrenaline 1:200,000 (group III), or 4 mL of 1% lidocaine (group IV) for local infiltration, respectively. Heart rate, systolic blood pressure (BP), diastolic BP, and mean arterial pressure were monitored continuously in radial artery.
Significant hemodynamic changes, particularly decrease of BP (p < 0.001) with slightly increased heart rate (p < 0.001) approximately 1.5 minutes after local infiltration, were observed in group I, group II, and group III compared with the baseline, but not in group IV. However, no significant hemodynamic changes were observed between group I, group II, and group III at the same time points (p > 0.05).
Local infiltration of low-dosage adrenaline causes temporary significant hemodynamic changes, particularly marked decrease of BP during FESS, and there were no significant hemodynamic changes between adrenaline 1:200,000 and 1:400,000.
局部麻醉剂中含有的低剂量肾上腺素常用于功能性鼻内镜鼻窦手术（FESS）中的止血，但常引起显著的血流动力学副作用，而这些副作用可能被忽视。一项随机、对照、前瞻性临床试验旨在探究全身麻醉下FESS期间局部浸润不同浓度和/或不同剂量肾上腺素后的这些影响。
108例成年患者被随机分为四组之一，分别接受2 mL 2%利多卡因和1:200,000肾上腺素（I组）、4 mL 1%利多卡因和1:400,000肾上腺素（II组）、4 mL 1%利多卡因和1:200,000肾上腺素（III组）或4 mL 1%利多卡因（IV组）进行局部浸润。通过桡动脉连续监测心率、收缩压（BP）、舒张压和平均动脉压。
与基线相比，I组、II组和III组在局部浸润后约1.5分钟观察到显著的血流动力学变化，特别是血压下降（p < 0.001），心率略有增加（p < 0.001），而IV组未观察到。然而，在相同时间点，I组、II组和III组之间未观察到显著的血流动力学变化（p > 0.05）。
低剂量肾上腺素局部浸润会引起暂时的显著血流动力学变化，特别是在FESS期间血压明显下降，且1:200,000和1:400,000肾上腺素之间的血流动力学变化无显著差异。
