Epinephrine Use in Endoscopic Ear Surgery: Quantitative Safety Assessment

By June 7, 2019

Alicandri-Ciufelli, Matteo1; Molinari,Giulia1; Beckmann, Sven2 ; Caversaccio, Marco2 ; Livio Presutti1, Anschuetz, Lukas2
1 Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Modena, Modena, Italy;
2 Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.

The management of bleeding in exclusive endoscopic ear surgery (EES) is largely dependent on epinephrine use. However, to date its suitability and safety has not been assessed. The aim of the present study is to assess the safety profile of topical application and/or local infiltration of diluted epinephrine during EES regarding the intra- and postoperative periods. We hypothesize that epinephrine may be safely used during EES.

– Study Design: Case series with chart review.
– Setting: Tertiary referral center.
– Patients: Retrospective analysis of 90 EES cases performed at the University Hospital of Modena, Italy. Patient’s charts and video recordings of the operations were assessed.
-Interventions: Diagnostic and therapeutic

Main Outcome Measures: intraoperative and post-operative possible adverse reactions related to intraoperative epinephrine use

Epinephrine was used in all cases for hemostatic purposes as following: (1) diluted epinephrine (1:200.000) injection: mean 1.2 mL (range: 0 – 3.5) corresponding to 0.006 mg (range 0 – 0.018) and topical application (1:1000) directly in the surgical field: mean 7 cottonoids (range: 0 – 18) corresponding to mean 0.56 mg (range: 0 – 1.44).
No major cardiovascular adverse effects were assessed. Otherwise only 2 intraoperative hypertensive events were recorded. One sensorineural hearing loss was observed in a case of cholesteatoma involving the stapes, no facial palsy occurred during the study period.

The combined use of local injection and topical epinephrine is a safe and effective strategy to control bleeding in exclusive EES, when used within the dilutions and quantities reported in this study.