Risks of Adrenalin Use in Endonasal Operations

Authors: P. Komínek;  P. Matoušek;  J. Chalupa *;  M. Groborzová **
Authors‘ workplace: ORL oddělení Nemocnice ve Frýdku Místku, primář MUDr. P. Komínek, Ph. D. ARO Nemocnice ve Frýdku Místku, primář MUDr. J. Chalupa, * Lékárna Nemocnice ve Frýdku Místku, vedoucí PhMr. M. Groborzová **
Published in: Otorinolaryng. a Foniat. /Prague/, , 2003, No. 2, pp. 83-89.


The local use of adrenalin is a standard part of endonasal operations, the objectivebeing to restrict mucosal bleeding during surgery. Adrenalin is used as a rule mixed with localanaesthetic, it is administered either topically on tampons or by injection infiltration of the mucosa.The use of adrenalin be associated with serious systemic complications. The authors describe twocases of young healthywomen whodeveloped ventricular fibrillation after infiltration of the mucosawith the anaesthetic containing adrenalin.The systemic effects of adrenalin are influenced by a number of factors - concentration and amountof administered adrenalin, the method of general anaesthesia, the general condition and associateddiseases of the patient. During injection infiltration of the mucosa the systemic effects of adrenalinare more marked than during its surface application. For infiltration as a rule adrenalin solutionsof a concentration 1:100 000 are recommended, for surface anaesthesia and vasoconstriction solutionswith a concentration of 1:1000 - 1:20 000. Individual doses of adrenalin should not exceed 0.1mg, the total dose 0.3 mg.Adrenalin should be used only incarefully monitored patientsandanaesthesia shouldbe sufficientlydeep. From anaesthesia halothane should be eliminated which potentiates the arythmogenic actionof adrenalin. Modern inhalation anaesthetics such as isofluran and sevofluran should have preferenceor else intravenous anaesthetics.The authors use for surface anaemisation in endonasal operations oxymethazoline (Nasivin), anadrenalin solutin 1:10 000, for infiltration of the mucosa an adrenalin solution 1:100 000. They havethe preparations prepared in the pharmacy in bottles of 10 ml and the two solutions are for safetyreasons differentiated by colour. Preparation of solutions of different concentrations by using dropsof undiluted adrenalin into the anaesthetic in the operation theatre may be associated with errorsand therefore the authors do not recommend it.

Key words:
adrenalin, concentration, systemic undesirable effects, general anaesthesia, risk of use.

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Audiology Paediatric ENT ENT (Otorhinolaryngology)
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