Making endoscopic sinus surgery safer

Techniques to make sinus surgery safer to be presented as an oral presentation at the American Rhinologic Society (national conference for sinus surgeons) at the Combined Otolaryngology Spring Meetings April 27 - 28, 2017, San Diego, California


Administration of topical 1:1000 epinephrine is commonly used in practice to achieve vasoconstriction during endoscopic sinus surgery and skull base surgery; however real-time effects on cardiovascular changes from systemic absorption have not been well studied. This may by significant in patients with cardiovascular disease.  This study utilized hemodynamic monitoring through intra-operative arterial line placement to provide a continuous measurement of a patient’s blood pressure, pulse, and mean arterial pressure..


20 patients undergoing endoscopic trans-sphenoidal resection of a pituitary lesion at a single institution were included into the study. Following arterial line placement by anesthesiology, six cottonoid pledgets soaked in 1:1000 epinephrine were placed into the bilateral nasal passages. Hemodynamic parameters including heart rate, blood pressure, and mean arterial pressure were collected at baseline, 30 seconds, and increments in minutes up to 5 minutes.  Continuous real time patient data was also collected from the anesthesia machine and analyzed.  Cottonoid pledgets soaked in saline were used on control patients. Additional potentially confounding factors such as use of beta-blockers, stress dose steroids, and positioning with head pins were all performed following termination of data collection.


The majority of patients showed no significant change following placement of epinephrine soaked cottonoids (P<.05). In a select few patients there were transient increases in blood pressure noted as soon as 30 seconds following administration of topical epinephrine, however return to baseline cardiovascular values were noted after an average of three minutes. There was no correlative preoperative characteristic that predicted sensitivity to placement of epinephrine. There were no lasting or permanent effects. There were no significant hemodynamic changes associated with the placement of saline soaked cottonoids.


Topical 1:1000 epinephrine use for endoscopic sinus surgery shows no significant hemodynamic changes with the vast majority of patients showing no effects following application. There can be transient increases in blood pressure in some patients, however these values returned to baseline after an average of three minutes.