Plasma adrenaline concentrations during functional endoscopic sinus surgery

Objectives/Hypothesis: Vasoconstrictors (i.e., epinephrine) are routinely a pplied before functional endoscopic sinus surgery (FESS) but may have signi ficant cardiac side effects. The controversy concerning clinical applicatio n of adrenaline is discussed. Study Design: In a prospectively controlled s tudy of 51 patients undergoing FESS we evaluated the absorption of adrenali ne from standard cotton pledgets and sub mucous infiltration and the incide nce of related side effects during surgery. Additionally, a control group o f 12 patients undergoing tonsillectomy was investigated. Methods: Plasma ad renaline concentrations were measured 1) before anesthesia, 2) after intuba tion, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1: 1000) and submucous infiltration with 2 mt lidocaine with adrenaline 1:100, 000 in each side, and 4) at end of surgery, The catecholamines were determi ned with a Merck-Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt , Germany), Pulse, electrocardiogram (ECG), and blood pressure were monitor ed. Results: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart f requency was unaffected during surgery. All patients in the adrenaline grou p showed significant increase in plasma adrenaline (AD) concentrations in t he third and fourth sample (P < .001), The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surg ery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients, Conclusions: Although systemic absorption of locally injected vasoconstrict ors occurs, adrenaline-related side effects during FESS are extremely rare when the patient is monitored exactly.