Efficacy and safety of high-concentration adrenaline wicks during functional endoscopic sinus surgery.

BACKGROUND

Epinephrine is a commonly used vasoconstrictor for instillation or infiltration to limit bleeding and improve the quality of the surgical field in functional endoscopic sinus surgery (FESS). No study to date has shown the efficacy of varying concentrations of adrenaline wicks into the nasal mucosa during FESS.

METHODS

A prospective, randomized, double-blind pilot study was conducted in which 30 American Society of Anesthesiologists (ASA) class I and II patients aged 20 to 60 years were divided into two groups. Patients in group 1 and 2 received 1 and 4 mg of epinephrine, respectively, with a nasal pack soaked in 20 mL of saline for 10 minutes before surgery after induction of anesthesia. A standard anesthesia protocol was followed using morphine, propofol, vecuronium with oxygen, and nitrous oxide. Patients were monitored for assessment of the surgical field and the amount of blood loss during FESS. Patients were also monitored for heart rate, invasive blood pressure, and cardiac output to assess the safety of varying concentrations of adrenaline wicks. Blood loss was measured meticulously. The surgical field was assessed by a surgeon blinded to the patient group using the Boezaart scale. Hemodynamic instability (± 20% of baseline values) was treated by rescue drugs (nitroglycerin infusion, metoprolol).

RESULT

Blood loss was found to be significantly decreased in group 2 compared to group 1 (p < .05). The rescue medication requirement to treat hypertension was more in group 2 than in group 1 (p < .05) but within the recommended limits. There was no significant difference in cardiac output between the two groups.

CONCLUSION

High-concentration (4 mg in 20 mL of saline) adrenaline wicks used during FESS significantly improve the quality of the surgical field and decrease blood loss compared to low-concentration (1 mg in 20 mL saline) wicks. Associated hemodynamic changes can be controlled in both groups without significant clinical consequences.