Efficacy of Topical Epinephrine in Tympanoplasty.
Administration, Topical
Adolescent
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
/ prevention & control
Blood Pressure
/ drug effects
Child
Child, Preschool
Dose-Response Relationship, Drug
Epinephrine
/ administration & dosage
Female
Heart Rate
/ drug effects
Hemostasis, Surgical
/ methods
Humans
Male
Middle Aged
Prospective Studies
Treatment Outcome
Tympanoplasty
/ adverse effects
Vasoconstriction
/ drug effects
Vasoconstrictor Agents
/ administration & dosage
Young Adult
Epinephrine
efficacy
hemostasis
safety
tympanoplasty
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
25
05
2021
received:
18
01
2021
accepted:
01
06
2021
pubmed:
23
6
2021
medline:
7
10
2021
entrez:
22
6
2021
Statut:
ppublish
Résumé
To compare the hemostatic effects of commonly used concentrations of topical epinephrine in tympanoplasty. Prospective, randomized, controlled clinical trial. Patients undergoing tympanoplasty were randomized to receive topical epinephrine at 1:1,000 or 1:10,000. With the investigators blinded, hemostasis was assessed with a modified Boezaart scale. Vasoconstriction was measured by laser Doppler. Blood pressure and pulse were tracked. Thirty patients, 4 to 84 years old, were studied, with 15 patients per group. Boezaart scores dropped a mean of 67% and 62% with 1:1,000 and 1:10,000, respectively (P = .44). Capillary blood flow decreased a mean of 50.4% and 50.9% with 1:1,000 and 1:10,000, respectively (P = .95). The mean change in heart rate and mean arterial pressure after topical epinephrine exposure were -4.9 and -0.73 beats per minute (P = .15), and -0.60 and -0.73 mmHg (P = .96) for 1:1,000 and 1:10,000 respectively. No adverse events occurred in either group. Topical epinephrine at 1:10,000 has hemostatic efficacy comparable to 1:1,000 in tympanoplasty. Although both concentrations appear safe, use of topical epinephrine 1:10,000 should be considered over 1:1,000 to minimize the potential for adverse events. 2 Laryngoscope, 131:2319-2322, 2021.
Substances chimiques
Vasoconstrictor Agents
0
Epinephrine
YKH834O4BH
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2319-2322Subventions
Organisme : University of Florida
Informations de copyright
© 2021 The American Laryngological, Rhinological and Otological Society, Inc..
Références
Gessler EM, Hart AKE, Dunlevy TM, Greinwald JH. Optimal concentration of epinephrine for vasoconstriction in ear surgery. Laryngoscope 2001;111:1687-1690.
Richa F, Yazigi A, Sleilaty G, Yazbeck P. Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty. Eur J Anaesthesiol 2008;25:369-374.
Schwalm J-D, Hamstra J, Amin M, Velianou JL. Cardiogenic shock following nasal septoplasty: a case report and review of the literature. Can J Anesth/J Can d'anesthésie 2008;55:376-379.
Chelliah YR, Manninen PH. Hazards of epinephrine in Transsphenoidal pituitary surgery. J Neurosurg Anesthesiol 2002;14:43-46.
Shah RK, Hoy E, Roberson DW, Nielsen D. Errors with concentrated epinephrine in otolaryngology. Laryngoscope 2008;118:1928-1930.
Canada IFS Medication P. Fatal outcome after inadvertent injection of epinephrine intended for topical use. Can J Hosp Pharm 2009;62:245-247.
Wanamaker HH, Arandia HY, Wanamaker HH. Epinephrine hypersensitivity-induced cardiovascular crisis in Otologic surgery. Otolaryngol Head Neck Surg 1994;111:841-844.
O'Malley TP, Postma GN, Michael Holtel A, Girod D. Effect of local epinephrine on cutaneous bloodflow in the human neck. Laryngoscope 1995;105:140-143.
Dunlevy TM, O'Malley TP, Postma GN. Optimal concentration of epinephrine for vasoconstriction in neck surgery. Laryngoscope 1996;106:1412-1414.
Hirshowitz B, Eliachar I. Effective haemostasis with local anaesthesia in nasal surgery. Br J Plast Surg 1972;25:335-341.
Lee WC, Ramsden TR, Walter N. Local and regional anesthesia for functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol 1997;106:767-769.
Mcclymont LG, Crowther JA. Local anaesthetic with vasoconstrictor combinations in septal surgery. J Laryngol Otol 1988;102:793-795.
Higgins TS, Hwang PH, Kingdom TT, Orlandi RR, Stammberger H, Han JK. Systematic review of topical vasoconstrictors in endoscopic sinus surgery. Laryngoscope 2011;121:422-432.
Carpenter RL, Kopacz DJ, Mackey DC. Accuracy of laser Doppler capillary flow measurements for predicting blood loss from skin incisions in pigs. Anesth Analg 1989;68:308-311.
Boezaart AP, Merwe Johan VD, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 1995;42:373-376.
Liu T, Qin M, Li W, Shen X. Effects of a single dose Dexmedetomidine on surgical field visibility during middle ear microsurgery. Otol Neurotol 2016;37:680-684.
Yim MT, Ahmed OG, Takashima M. Evaluating real-time effects of topical 1:1000 epinephrine in endoscopic sinus and skull-base surgery on hemodynamic parameters through intraoperative arterial line monitoring. Int Forum Allergy Rhinol 2017;7:1065-1069.
National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Vol 7. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2004.
Faul F, Erdfelder E, Lang A-G, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175-191.
Gorvetzian JW, Epler KE, Schrader S, et al. Operating room staff and surgeon documentation curriculum improves wound classification accuracy. Heliyon 2018;4:e00728.
Anschuetz L, Bonali M, Guarino P, et al. Management of Bleeding in exclusive endoscopic ear surgery: pilot clinical experience. Otolaryngol Head Neck Surg 2017;157:700-706.
Chemmangath N, Aroor R, Pratap D, Bhat V. A comparative study between haemocoagulase and adrenaline in type 1 tympanoplasty. J Otol 2019;14:117-120.
Hamed RA, Hamed EM. Topical use of tranexamic acid versus epinephrine to optimise surgical field during exploratory tympanotomy. Anaesth Crit Care Pain Med 2020;39:771-776.
Lewis MA. Treatment and survival after massive overdose of adrenaline. Br Med J 1967;4:38.
Grissinger M. Fatalities after inadvertent injections of topical epinephrine. P T 2013;38:496-517.
Deacock AR. Aspects of anaesthesia for middle ear surgery and blood loss during stapedectomy. Proc R Soc Med 1971;64:1226-1228.
Lancer JM, Fisch U. Local anaesthesia for middle ear surgery. Clin Otolaryngol Allied Sci 1988;13:367-374.
Bennie RE, Miyamoto RT. Epinephrine-induced ventricular fibrillation during anesthesia for myringotomy and tube insertion. Otolaryngol Head Neck Surg 1994;111:824-826.
Alicandri-Ciufelli M, Molinari G, Beckmann S, Caversaccio M, Presutti L, Anschuetz L. Epinephrine use in endoscopic ear surgery: quantitative safety assessment. ORL J Otorhinolaryngol Relat Spec 2020;82:1-7.
Snow JC, Shamsai J, Sakarya I. Effects of epinephrine during halothane anesthesia in mastoidotympanoplastic surgery. Anesth Analg 1968;47:252-256.
Shen Y, Mei Teh B, Friedland PL, Eikelboom RH, Atlas MD. To pack or not to pack? A contemporary review of middle ear packing agents. Laryngoscope 2011;121:1040-1048.
Schonauer C, Tessitore E, Barbagallo G, Albanese V, Moraci A. The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J 2004;13:S89-S96.