Department of Otorhinolaryngology - Head and Neck Surgery, AOU Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Department of Otorhinolaryngology - Head and Neck Surgery, AOU Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy,
ORL J Otorhinolaryngol Relat Spec. 2020;82(1):1-7. doi: 10.1159/000503725. Epub 2019 Nov 19.
The management of bleeding in exclusive endoscopic ear surgery (EES) is largely dependent on epinephrine use. However, to date its suitability and safety have not been assessed. The aim of the present study would be to assess the safety profile of topical application and/or local infiltrationof diluted epinephrine during EES regarding the intra- and postoperative periods. We hypothesize that epinephrine may be safely used during EES.
Retrospective analysis of 90 EES cases performed at the University Hospital of Modena, Italy. Patient's charts and video recordings of the operations were assessed.
Epinephrine was used in all cases for hemostatic purposes as following: (1) diluted epinephrine (1:200,000) injection: mean 1.2 mL (range: 0-3.5) corresponding to 0.006 mg (range 0-0.018), and (2) topical application (1:1,000) directly in the surgical field: mean 7 cottonoids (range: 0-18) corresponding to mean 0.56 mg (range: 0-1.44). No major cardiovascular adverse effects were assessed. Only 2 intraoperative hypertensive events were recorded. One sensorineural hearing loss was observed in a case of cholesteatoma involving the stapes; no facial palsy occurred during the study period.
The combined use of local injection and topical epinephrine is a safe and effective strategy to control bleeding in exclusive EES, when used within the dilutions and quantities reported in this study.
在单纯内镜耳部手术（EES）中，出血的管理在很大程度上依赖于肾上腺素的使用。然而，迄今为止，其适用性和安全性尚未得到评估。本研究旨在评估 EES 术中及术后局部应用和/或局部浸润稀释肾上腺素的安全性。我们假设肾上腺素在 EES 中可以安全使用。
回顾性分析了意大利摩德纳大学医院进行的 90 例 EES 病例。评估了患者的病历和手术录像。
所有病例均因止血目的使用肾上腺素：（1）稀释肾上腺素（1:200,000）注射：平均 1.2 毫升（范围：0-3.5），相当于 0.006 毫克（范围：0-0.018）；（2）直接在手术部位局部应用（1:1,000）：平均 7 个棉片（范围：0-18），相当于平均 0.56 毫克（范围：0-1.44）。未评估到重大心血管不良事件。仅记录到 2 例术中高血压事件。在涉及镫骨的胆脂瘤病例中观察到 1 例感觉神经性听力损失；研究期间未发生面瘫。
在本研究报告的稀释度和用量范围内，局部注射和局部应用肾上腺素联合使用是控制单纯 EES 中出血的安全有效的策略。
