Comparison of local and systemic effects of different concentrations of adrenaline nasal packs in endoscopic sinus surgery

Endoscopicsinus surgery is the surgical procedure used in the management of chronic rhinosinusitis,benign nasal tumours as well as selected malignant nasal tumours as well as indiseases of the orbit. One of the challenges in endoscopic sinus surgery is propervisualization of anatomical landmarks and structures, due to the highvascularity of nose and paranasal sinuses. In addition to this, generalanaesthesia causes an overall vasodilatory effect in the body, leading to ahyperaemic nasal mucosa. Adrenaline used either topically or by infiltration,to achieve hemostasis, has become popular as it is inexpensive and easilyavailable in every hospital.Topical adrenaline in concentration of1:1000, is the most commonly used vasoconstrictor for nasal packing currently.It aids in achieving haemostasis and prolonging the duration of action of localanaesthetics when added with them. By acting on both alpha and beta adrenergicreceptors of the body, adrenaline produces effects like increasedvasoconstriction (locally and systemically) and increased heart rate, cardiacoutput and contractility.These physiological effects of adrenaline pose a riskof complications like  hypertension,coronary ischemia, ventricular dysrhythmias and cerebral haemorrhageetc.

The literatureregarding systemic absorption of adrenaline and comparing differentconcentrations of adrenaline and the effects it has on surgical visibility andhemodynamic parameters is very limited. Thus, this study is being done to assess thesystemic absorption of adrenaline present in nasal packs, the haemodynamiceffects caused by it and the improvement in surgical field obtained when twodifferent concentrations of adrenaline are used.