The systemic absorption of adrenaline from posterior segment infusion during vitreoretinal surgery

Adrenaline infused into the posterior segment of the eye during vitreoretinal surgery may be absorbed and give rise to unwanted cardiovascular effects. We sought to establish whether significant amounts of adrenaline are systematically absorbed.

This study was prospective and double-masked, with patients randomised into two groups. The first group received a posterior segment infusion containing Hartmann's solution alone (Hs group) and the second group received a posterior segment infusion of Hartmann's solution containing 0.5 ml of 1:1000 (0.5 mg) adrenaline per 500 ml (Hs + Ad group). Pre-medication and anaesthetic techniques were standardised for all patients. Venous blood samples were collected prior to induction, 5 min following intubation and 5, 10, 15 and 30 min following the commencement of the infusion. Samples were analysed for adrenaline levels using high-performance liquid chromatography.

Ten patients were studied: 4 in the Hs group and 6 in the Hs + Ad group. The mean dose of adrenaline administered in the Hs + Ad group was 655.08 nmol (0.12 mg). The median serum adrenaline level following infusion for the Hs + Ad group was 0.15 nmol/l (LQ = 0.100, UQ = 0.360) and the median serum adrenaline level for the Hs group was 0.10 nmol/l (LQ = 0.100, UQ = 0.350). There was no overall statistical difference in the levels of serum adrenaline between the two groups, and furthermore adrenaline levels remained within physiological parameters for both groups.

There does not appear to be significant adrenaline absorption from posterior segment infusion. Continued caution should be exercised, however, as idiosyncratic reactions may still occur.