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Safety of Topical Epinephrine Compared with Oxymetazoline in Pediatric Functional Endoscopic Sinus Surgery: A
Natalie Quinn1,2, Austin Schafer1,2, Megan McNutt1,2
1Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
Insights
Topical epinephrine is as safe as oxymetazoline for pediatric functional endoscopic sinus surgery (FESS). Hemodynamic parameters showed no significant differences between the two agents in this safety assessment.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Anesthesiology
Background:
- Topical vasoconstrictors are crucial in functional endoscopic sinus surgery (FESS) for hemostasis and visualization.
- Epinephrine, a potent vasoconstrictor, is used off-label in pediatric FESS, necessitating safety evaluation.
Purpose of the Study:
- To assess the safety of topical epinephrine compared to oxymetazoline in pediatric FESS.
- To evaluate hemodynamic stability during FESS utilizing topical epinephrine.
Main Methods:
- Retrospective review of pediatric FESS cases (0-14 years) in 2021.
- Comparison of hemodynamic parameters (heart rate, blood pressure) between cohorts receiving topical oxymetazoline versus epinephrine.
- Exclusion of patients without documented vasoconstrictor use or those receiving both/neither agent.
Main Results:
- 57 pediatric FESS patients met inclusion criteria; 28.07% received epinephrine, 71.93% received oxymetazoline.
- No significant differences in preoperative or intraoperative heart rate and blood pressure were observed between the epinephrine and oxymetazoline groups.
- No intraoperative antihypertensive medications were required in either cohort.
Conclusions:
- Topical epinephrine demonstrates a similar safety profile to oxymetazoline in pediatric FESS.
- Further prospective studies are recommended to confirm the efficacy and safety of topical epinephrine in pediatric FESS.
Objective:
To assess the safety of topical epinephrine during pediatric functional endoscopic sinus surgery (FESS).
Methods:
After obtaining IRB approval, electronic medical records of patients aged 0 to 14 undergoing FESS in 2021 were retrospectively reviewed and divided into 2 cohorts based on the topical vasoconstrictive agent utilized during the case: oxymetazoline or epinephrine. Patients without documentation of vasoconstrictor utilization or those who received both or neither vasoconstrictive agent were excluded. Outcome variables consisted of preoperative and maximum intraoperative heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, as well as administration of intraoperative propofol, fluids, and antihypertensive medications. Patients without documented preoperative HR, SBP, and DBP were additionally excluded from the study. Mean differences and adjusted mean differences were estimated using linear models adjusted for baseline.
Results:
Among a total cohort of 123 FESS patients, 57 met inclusion criteria and were primarily male (63%, n = 36) with a median age at procedure of 10.94 years (IQR 7.66, 13.31). Oxymetazoline was administered to 71.93% (n = 41) of the cohort, while 28.07% (n = 16) received epinephrine. The unadjusted and adjusted mean differences between all preoperative and intraoperative hemodynamic parameters were not significantly different between cohorts (P > .05 in all cases). No intraoperative antihypertensives were administered to patients in the study.
Conclusion:
Topical epinephrine and oxymetazoline have similar risk profiles in pediatric functional endoscopic sinus surgery. A prospective study should be developed to evaluate the efficacy of topical epinephrine and to further assess its safety profile.
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