Evaluating real‐time effects of topical 1:1000 epinephrine in endoscopic sinus and skull‐base surgery on hemodynamic parameters through intraoperative arterial line monitoring

Yim, Michael; Ahmed, Omar G.

doi:10.1002/alr.22012

Cited by 20 publications

(40 citation statements)

References 11 publications

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“…Two of 28 patients in this study had an SBP increase of >75 mmHg after pledget placement. There were no confounding factors identified in these patients, similar to our previous study . We observed a lower percentage of responders in this study compared with our previous study .…”

Section: Discussionsupporting

confidence: 89%

“…Orlandi et al observed 2 patients who had cardiovascular complications after topical epinephrine placement . Our group previously found that 6 of 26 patients had severe spikes in SBP after topical treatment . Our current results provide further supporting evidence that topical epinephrine may induce significant hemodynamic changes in a subset of sensitive individuals.…”

Section: Discussionsupporting

confidence: 84%

“…18 Our group previously found that 6 of 26 patients had severe spikes in SBP after topical treatment. 12 Our current results provide further supporting evidence that topical epinephrine may induce significant hemodynamic changes in a subset of sensitive individuals. Two of 28 patients in this study had an SBP increase of >75 mmHg after pledget placement.…”

Section: Discussionsupporting

confidence: 80%

“…There were no confounding factors identified in these patients, similar to our previous study . We observed a lower percentage of responders in this study compared with our previous study . In the current study, injectable epinephrine was administered first before topical epinephrine, which may have blunted or blocked absorption of the topical epinephrine.…”

Section: Discussionsupporting

confidence: 74%

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Real‐time hemodynamic effects of 1:100,000 and 1:200,000 injectable epinephrine and placement of topical 1:1000 epinephrine pledgets in patients undergoing endoscopic sinus and skull‐base surgery: a randomized, prospective study

Ahmed

Choi

et al. 2019

Int Forum Allergy Rhinol

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Background Intranasal injection of epinephrine and placement of topical epinephrine pledgets are methods to improve visualization during endoscopic sinonasal surgery. Studies comparing the hemodynamic effects of these vasoconstrictors using intraoperative arterial line monitoring are lacking. Methods Twenty‐eight patients undergoing endoscopic skull‐base surgery were enrolled in a prospective, randomized study. Patients were randomized to have either 2 mL of 1:100,000 or 2 mL of 1:200,000 epinephrine injected intranasally. Hemodynamic parameters, including pulse, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were collected using intraoperative arterial line monitoring for 5 minutes. Afterward, 1:1000 topical epinephrine‐soaked pledgets were placed in both groups, and the same parameters were collected for another 5 minutes. Results There was no statistical difference in change in pulse, SBP, DBP, and MAP between the 1:100,000 and 1:200,000 epinephrine groups. However, epinephrine injections did cause an increase in all hemodynamic parameters when compared with baseline (p < 0.05). Topical epinephrine pledgets placed after injection of epinephrine did not have any significant hemodynamic effects, except for 2 of 28 patients who had a >75‐mmHg increase in SBP. No preoperative characteristics were identified that predicted sensitivity to epinephrine. Conclusion There is no statistical difference in changes in hemodynamic parameters between injecting epinephrine 1:100,000 compared with 1:200,000 during endoscopic sinonasal surgery. In a subset of patients, placement of topical 1:1000 epinephrine pledgets had significant hemodynamic elevation requiring intervention and thus should be used judiciously depending on patient comorbidities.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 74%

See 2 more Smart Citations

Real‐time hemodynamic effects of 1:100,000 and 1:200,000 injectable epinephrine and placement of topical 1:1000 epinephrine pledgets in patients undergoing endoscopic sinus and skull‐base surgery: a randomized, prospective study

Ahmed

Choi

et al. 2019

Int Forum Allergy Rhinol

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View full text Add to dashboard Cite

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“…Evidence‐based evaluation of the safety profile of concentrated topical epinephrine is based on a systematic review of clinical trials (level 1 evidence), two prospective cohort studies (level 2 evidence), and two retrospective studies (level 3 evidence) …”

Section: Level Of Evidencementioning

confidence: 99%