Hemodynamic effects of locally applied epinephrine used with various general anesthetic techniques

Halothane-nitrous oxide-oxygen (GOF), nitrous oxide-oxygen with diallyl-nor-toxiferine (Jackson-Rees method), or nitrous oxide-oxygen with droperidol-pentazocine (modified NLA) were administered in 190 instances of repair of cleft lips and cleft palates. Epinephrine, 1:30,000, 1:100,000, or 1:300,000, was injected as the vasoconstrictor around the operative field. Epinephrine concentration of 1:100,000 provided sufficient hemostasis, whereas 1:300,000 was insufficient. With the same concentration of epinephrine, GOF and modified NLA seemed to be better than the Jackson-Rees method, since the GOF and modified NLA groups showed less increase of pulse rate, blood pressure, and plethysmographic changes. A 1:30,000 concentration of epinephrine could be used safely with the Jackson-Rees method and the hemostasis with this concentration was superior to 1:100,000. However, it is recommended only for the cleft lip operation, since these patients are younger and need better hemostasis, and hypersalivation after reversal does not disturb the postoperative course. So-called epinephrine-induced arrhythmia with halothane anesthesia occurred in 1 of 34 instances with 1:300,000 solution and in 5 of 48 instances with 1:100,000 solution. Propranolol was given in only one instance. All others returned to normal rhythm with hyperventilation with pure oxygen. The use of 1:100,000 solution of epinephrine as an adjunct with modified NLA is the most satisfactory and safe method for cleft palate operations, and 1:30,000 with the Jackson-Rees is the better method for cleft lip repairs.