• Richard R Orlandi, Smitha Warrier, Stephan Sato, and Joseph K Han.
• Division of Otolaryngology-Head and Neck Surgery, University of Utah, and Section of Otolaryngology-Head and Neck Surgery, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA. richard.orlandi@hsc.utah.edu
• Am J Rhinol Allergy. 2010 Mar 1; 24 (2): 140-2.

BackgroundThe safety of topical epinephrine (1:1000 concentration) has recently been called into question. No objective data have been presented examining this issue.MethodsWe retrospectively reviewed all cases of endoscopic sinus surgery performed by the senior authors at their respective institutions. Perioperative records were reviewed for use of topical 1:1000 epinephrine and for any intraoperative or postoperative complications related to its use.ResultsDuring the study periods, 1998 cases of endoscopic sinus surgery were identified where topical 1:1000 epinephrine was used. Two complications were identified (0.1%), one at each institution. One patient suffered coronary artery vasospasm, attributed to the use of topical 1:1000 epinephrine during surgery. The other patient developed transient intraoperative hypertension immediately after inadvertent submucosal injection of concentrated epinephrine. This event was caused by an erroneous switch with the 1% lidocaine/1:100,000 solution. This error occurred early in the institution's experience with concentrated topical epinephrine. After implementation of additional preventative safeguards, no further errors or complications have occurred.ConclusionConcentrated epinephrine has the potential for complications when used during endoscopic sinus surgery. Nevertheless, with appropriate safeguards described in this study, its topical use is safe.

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