Objective: To assess the safety and efficacy of topical epinephrine in adults undergoing endoscopic sinus surgery (ESS).
Data Sources: PubMed, Embase, and Ovid MEDLINE online databases.
Review Methods: Non-case report English articles studying the effects of topical epinephrine as the topical vasoconstrictor used in adult ESS were found from the online databases through January 2019. The PRISMA literature selection process was used (Preferred Reporting Items for Systematic Reviews and Meta-analyses).
Results: An overall 2216 articles were identified, with 9 meeting inclusion criteria involving a total of 5043 patients. All 9 studies assessed the safety of topical epinephrine, while 5 examined efficacy. Intraoperative average blood loss (ABL) ranged from 60 to 426 mL. Topical epinephrine concentrations varied from 1:1000 to 1:100,000, and 3 major complications were found for a rate of 0.06%. There were no reports of ophthalmic, orbital, or skull base injury, nor were there reports of cerebrospinal fluid leaks. A meta-analysis was performed on the 4 studies examining ABL. Estimated mean (95% CI) ABL was 119.4 mL (39.1-199.6) in the higher-concentration cohort (>1:10,000) and 372.2 mL (296.8-447.5) in the lower-concentration cohort (≤1:10,000) ( = .001).
Conclusion: Topical epinephrine is generally safe and provides acceptable hemostasis during ESS, with higher concentrations (>1:10,000) providing improved hemostasis. Caution is advised for its use in patients with preexisting cardiovascular disease or in combination with other topical or injected vasoconstrictive agents. More prospective comparative studies are necessary to determine the ideal hemostatic concentration of epinephrine in ESS.
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http://dx.doi.org/10.1177/0194599820915478 | DOI Listing |
Syst Rev
January 2025
Department of Pediatric, Affiliated Chifeng Clinical College of Inner, Mongolia Medical University, Chifeng, China.
Background: There is ongoing debate about the safety and efficacy of epicutaneous immunotherapy (EPIT) in treating food allergies. The systematic review and meta-analysis aimed to evaluate the safety and efficacy of EPIT.
Methods: We systematically searched international trial registers (ClinicalTrials.
Dent Res J (Isfahan)
November 2024
School of Dental Medicine, Boston University Henry. M. Goldman, Boston, Massachusetts, USA.
Background: No consensus has been reached on the effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful inferior alveolar nerve (IAN) block. This study aimed to assess the effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful IAN block.
Materials And Methods: This double-blind randomized controlled clinical trial was conducted on 45 patients with irreversible pulpitis.
JA Clin Rep
December 2024
Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Background: Local anesthetic systemic toxicity (LAST) is a rare but potentially life-threatening complication. Under general anesthesia, neurological signs are often masked, delaying diagnosis and increasing the risk of sudden cardiovascular collapse. Therefore, early detection methods are critically needed.
View Article and Find Full Text PDFWorld J Plast Surg
January 2024
Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Background: Hemorrhage during rhinoplasty may impair the surgeon's visibility. Our objective was to examine the impact of subcutaneously administered Tranexamic acid (TXA) on bleeding during rhinoplasty.
Methods: A three-blind randomized clinical trial including 60 patients undergoing nose surgery was conducted to compare the effects of two different anesthetic solutions on surgery results.
J Otolaryngol Head Neck Surg
October 2024
Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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