The effect of clysed and topical epinephrine on intraoperative catecholamine levels

Background: Epinephrine administration for hemostasis during burn wound exc ision may produce potential anesthetic risks, Two patient groups were studi ed to determine the absorption of either topical concentrated epinephrine o r exogenously injected dilute epinephrine, Methods: For the topical group (10 patients, 10 procedures), excision of wo unds under tourniquet was performed, followed by epinephrine (1 mg/10 mL) g auze with pressure wrapping. For the clysis group (9 patients, 12 procedure s), donor sites were injected with 0.5 mg epinephrine/1,000 mL lactated Rin ger's solution before harvest. Nine intraoperative serum samples were colle cted and frozen during each procedure for epinephrine and norepinephrine as say. Results: Concentrated epinephrine (67 mL) was topically applied to excise 1 ,362 cm(2). Dilute epinephrine (1,350 mL) was clysed to obtain 1,950 cm(2) autograft. No significant increases in the serum catecholamines or changes in the cardiovascular profiles occurred. Conclusion: The administration of either topical or clysed epinephrine duri ng acute burn excision does not cause any side effects for safe anesthetic management; there were no detectable increased plasma levels of epinephrine or norepinephrine. Epinephrine provides the burn surgeon with two safe met hods for controlling intraoperative blood loss.