Hemostatic and Hemodynamic Effects of Topical Administration versus Intranasal Injection of Adrenaline during Endoscopic Sinus Surgery: A Prospective Observational Study

[摘要] Aim:  The study intents to compare the hemostatic and hemodynamic effects of topical application versus intranasal injection of adrenaline during endoscopic sinus surgery (ESS) under general anesthesia (GA). Materials and Methods:  This is a tertiary hospital-based, 1-year prospective observational study in fifty adults, within the age group of 18–70 years of both sexes with bilateral similar sinonasal pathology, who underwent ESS under GA. Intraoperative hemostatic and hemodynamic parameters following topical application and intranasal injection of adrenaline were analyzed. Results:  It was found that Fromme–Boezaart grading for hemostasis did not show any statistically significant difference (P 0.05) between topical versus injection adrenaline. Out of fifty patients, 74% showed <10-ml difference in blood loss and only 6% of the study population showed more than 20-ml difference in blood loss. The heart rate and mean arterial pressure were found to be increased following intranasal injection of adrenaline (P < 0.001). Six percent of the study population developed electrocardiogram variation in the form of sinus tachycardia following local infiltration of adrenaline. Conclusions:  Topical application of 1:2000 dilution of adrenaline gives similar hemostatic effects compared to intranasal infiltration of 1:100,000 dilution of adrenaline during ESS, and thus, we can avoid the systemic adverse events such as tachycardia, arrhythmia, and mean arterial pressure changes due to adrenaline infiltration.

[学科分类] 皮肤病学

[关键词] Endoscopic sinus surgery;hemodynamics;hemostasis;topical adrenaline