Acute Massive Pulmonary Oedema and Myocardial Ischaemia after Adrenaline Intranasal Pack Application
Adrenaline intranasal pack is one of the convenient and efficient vasoconstrictors used for infiltration to limit bleeding and improve the quality and visibility of the surgical field during endoscopic sinus surgery. However, some studies report that adrenaline causes severe side effects in-term of hemodynamic stability and pulmonary edema in some patients. Therefore, this study is designed to explore and compare the efficacy and safety of two different doses of adrenaline intranasal pack. A randomized double-blind study was conducted in the department of Internal Medicine and ENT department of Dr Sulaiman Al Habib Hospital Dubai Healthcare City Dubai United Arab Emirates from January 2020 to Janurary 2021. A total of 20 patients were randomly assigned into 2 groups: group 1 received 1 mg adrenaline and group 2 received 4 mg adrenaline intranasal pack soaked in normal saline after the administration of general anaesthesia. The patients were assessed for hemodynamic parameters and blood loss throughout the surgery. Adrenaline administration remarkably raised the blood pressure and pulse rate in both groups. The hemodynamic parameters were found to be more unstable in group 2 as compared to group 1. The partial pressure of oxygen was decreased more in group 2 as compared to group 1. The requirement of rescue medication to stabilize hemodynamic parameters was more in group 2 than in group 1 but within the recommended range. The blood loss was found to be significantly decreased in group 2 (adrenaline 4 mg) compared to group 1 (adrenaline 1 mg). Group 2 provides a clear surgical field throughout the surgery. In conclusion it is recommended that adrenaline is a potent vasoconstrictor, but the increased levels of adrenaline are responsible for causing cardiac toxicity.