Otolaryngology, ENT Conference

Biography

Cassie Dow is a medical student from the University of New South Wales in Sydney, Australia. She has particular research interests in safety in sino-nasal surgery.

 

Abstract

Abstract

Topical adrenaline is used as a vasoconstrictor in sino-nasal surgeries to provide visualisation for the surgeon and reduce blood loss. Concerns exist around the use of concentrated 1:1000 adrenaline due to its potential for systemic effects.

Aim: To determine whether 1:1000 topical adrenaline produces worse intraoperative hemodynamic stability compared to 1:10,000 topical adrenaline and whether it provides improved visualization.

Methods: A randomised, blinded, prospective non-inferiority trial was performed. Topical 1:1000 or topical 1:10,000 was placed in one nasal passage. Haemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) were measured prior to insertion and minutely for ten minutes after insertion. This was repeated in the other nasal passage of the same patient with the other concentration. The surgeon was asked to grade the visual field of each passage using the Boezaart Scale (1). 

Results: Nineteen patients were assessed (9 females, 32.79±11.36 years). The means of the greatest absolute change in parameters were compared between concentrations using a linear mixed effects model, where the upper bounds of the confidence interval for all remained below the pre-determined clinical non-inferiority margin (Δ = 10mmHg, 10bpm). There was a statistically significant greater change in HR in the 1:1000 group (p= 0.046). The 1:10,000 had a mean visual grade of 2.11, while the 1:1000 had a mean of 1.53. A Wilcoxon Rank-Signed test found this difference significant (p=0.012). 

Conclusion: Topical 1:1000 adrenaline provides no worse intraoperative haemodynamic stability compared to topical 1:10,000 but affords superior visualisation and thus should be used to optimise surgical conditions.