Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Abstract

During endoscopic orthopedic surgery, epinephrine mixed with irrigation saline is frequently used to improve visualization. By monitoring hemodynamic parameters throughout the procedure, we intended to discover the hemodynamic effect of epinephrine between the normal saline irrigation fluid without epinephrine group (NS) and normal saline irrigation fluid with epinephrine group (EPI).Patients who underwent 1-level lumbar decompression or discectomy surgery without fusion between August 2019 and July 2020 were reviewed retrospectively. The hemodynamic parameters were compared between the NS group and EPI group. As a second endpoint, the incidence of hypotension and hypertension events, expected blood loss, postoperative nausea and vomiting and postoperative epidural hematoma were compared between the 2 groups.The 2 groups were homogeneous in terms of age, sex, weight, height, body mass index (BMI), ASA physical status (ASA PS), and diagnosis. The incidence of hypotension events (67.2 % in the NS group, 45.7 % in the EPI group, P =.015) and severe hypotension events (51.7 % in the NS group, 28.6 % in the EPI group, P = .015) were less frequent in the EPI group. Only epinephrine had a significant protective effect through a multivariable analysis (P = .027, OR = 2.361) and in severe hypotension events, only epinephrine had a significant protective effect through a multivariable analysis (P = .011, OR = 2.818), and EBL was the risk factor through a multivariable analysis (P = .016, OR = 1.002)We believe that the addition of epinephrine to irrigation saline has hemodynamic protective effects in patients who underwent endoscopic lumbar surgery.

Perioperative Takotsubo Stress Cardiomyopathy During Endoscopic Spinal Surgery

“…We used gravity-assisted pumping at 3-feet height from working field, giving IP of approximately 33 mm Hg by formula: 10 Height ðcmÞO1:36 = IP ðmmHgÞ Studies have suggested that while allowing constant lavage through independent ports of inflow and outflow under pressure-controlled automated-pump system, the inflow pressure should be set to 30 mm Hg [11][12][13] . Fluid uptake results in expansion of the intravascular volume, culminating in fluid overload and dilutional hyponatraemia 14,15 . No correlation was found between BMI and absorption of fluid into the epidural space 11 .…”