Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions

Fernández-Cossío, Sergio; Rodriguez-Dintén, M.J.; Gude, Francisco; Fernández-Álvarez, José Manuel

doi:10.1007/s00266-016-0673-2

Cited by 8 publications

(8 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While it has been concluded that topical 1:1000 epinephrine is generally safe to use, 3,6 the literature has reported a variety of results regarding the safety of concentrated 1:1000 epinephrine. In other prospective studies, the use of a variety of administration methods 7,8 and the mixing of epinephrine with other vasoconstrictors 9,10 has made it difficult to assess the use of topical 1:1000 epinephrine alone. 4,11,12 Further, heterogeneity between patients with regard to propensity for bleeding (especially in the context of chronic oxymetazoline use) and idiosyncrasies in hemodynamic response are confounding factors.…”

Section: Discussionmentioning

confidence: 99%

A Non-inferiority Trial: Safety and Efficacy of Topical 1:1000 versus 1:10 000 Epinephrine in Sino-nasal Surgeries

Dow

Sideris

Singh

et al. 2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: This study aimed to test the non-inferiority of topical 1:1000 epinephrine compared to topical 1:10 000 with regard to intraoperative hemodynamic stability, and to determine whether it produced superior visibility conditions. Methods: A single-blinded, prospective, cross-over non-inferiority trial was performed. Topical 1:1000 or topical 1:10 000 was placed in 1 nasal passage. Hemodynamic parameters (heart rate, systolic and diastolic blood pressures, and mean arterial pressure) were measured prior to insertion then every minute for 10 minutes. This was repeated in the contralateral nasal passage of the same patient with the alternate concentration. The surgeon graded the visualization of each passage using the Boezaart Scale. The medians of the greatest absolute change in parameters were compared using a Wilcoxon Rank-Signed test and confidence intervals were calculated using a Hodges-Lehman test. The non-inferiority margin was pre-determined at 10 bpm for heart rate and 10 mmHg for blood pressures. A Wilcoxon Rank-Signed test was used to assess superiority in visualization. Results: Thirty-two patients were enrolled and after exclusions, nineteen were assessed (mean age = 35.63 ± 12.49). Differences in means of greatest absolute change between the 2 concentrations were calculated (heart rate = 2.49 ± 1.20; systolic = −1.51 ± 2.16; diastolic = 2.47 ± 1.47; mean arterial pressure = 0.07 ± 1.83). In analyses of medians, 1:1000 was non-inferior to the 1:10 000. There was a significant difference (–0.58 ± 0.84; P = .012) in visualization in favor of topical 1:1000. Conclusion: Topical 1:1000 epinephrine provides no worse intraoperative hemodynamic stability compared to topical 1:10 000 but affords superior visualization and should be used to optimize surgical conditions.

show abstract

Section: Discussionmentioning

confidence: 99%

A Non-inferiority Trial: Safety and Efficacy of Topical 1:1000 versus 1:10 000 Epinephrine in Sino-nasal Surgeries

Dow

Sideris

Singh

et al. 2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…[ 47 ] Fibrin sealant can decrease postoperative bleeding and hematoma formation. [ 52 ] Multimodal opioid-sparing analgesia with paracetamol and ibuprofen should be used in standard orthognathic uncomplicated procedures. [ 58 ]…”

Section: Discussionmentioning

confidence: 99%

“…A prospective nonrandomized study compared a 4% cocaine chlorhydrate solution with another solution containing epinephrine at a 1:1000 dilution. Although both treatments worked well, bleeding and field visibility were reported to be better when the solution with cocaine was used[ 52 ] (OCEBM Level III). We use soaked neurosurgical pads with 2% cocaine and 1:1000 epinephrine solution, squeezing out the excess to reduce the likelihood of postoperative headache.…”

Section: R Esultsmentioning

confidence: 99%

Fast-track orthognathic surgery: An evidence-based review

Otero

Detriche

Mommaerts

2017

Ann Maxillofac Surg

View full text Add to dashboard Cite

The aim of this study was to establish a fast-track protocol for bimaxillary orthognathic surgery (OGS). Fast-track surgery (FTS) is a multidisciplinary approach where the pre-, intra-, and postoperative management is focusing maximally on a quick patient recovery and early discharge. To enable this, the patients’ presurgical stress and postsurgical discomfort should be maximally reduced. Both referral patterns and expenses within the health-care system are positively influenced by FTS. University hospital-literature review through Medline, Embase, and the Cochrane Library (January 2000–July 2016) using the following words – “fast track, enhanced recovery, multimodal, and perioperative care” – to define a protocol evidence based for OGS, as well as evidenced-based medicine search of every term added to the protocol during the same period. The process has resulted in an OGS protocol that may improve the outcome of the patient through several nonoperative and operative measures such as preoperative patient education and intra/postoperative measures that should improve overall patient satisfaction, decrease morbidity such as postoperative nausea, headache, dizziness, pain, and intubation discomfort, and shorten hospital stay. A literature review allowed us to fine-tune a fast-track protocol for uncomplicated OGS that can be prospectively studied against currently applied ones.

show abstract

“…Although adopted by some providers as means to reduced TBLB-related haemorrhage, the use of prophylactic instillation of diluted epinephrine into the target bronchus before attempting TBLB is not established in the literature. The main body of evidence regarding the efficacy and safety of prophylactic topical epinephrine for the prevention of haemorrhage is derived from the surgical literature, specifically endoscopic endonasal and sinus surgery, rhinoplasty and surgical management of burn injuries 22–25…”

Section: Introductionmentioning

confidence: 99%

Prophylactic epinephrine for the prevention of transbronchial lung biopsy-related bleeding in lung transplant recipients (PROPHET) study: a protocol for a multicentre randomised, double-blind, placebo-controlled trial

et al. 2019

View full text Add to dashboard Cite

IntroductionTransbronchial lung biopsy (TBLB) is frequently performed in single-lung and double-lung transplant recipients for evaluation of clinical and radiological findings as well as routine surveillance for acute cellular rejection. While rates of clinically significant TBLB-related haemorrhage are <1% for all comers, the incidence in lung transplant recipients is reported to be higher, presumably due to persistent allograft inflammation and alterations in allograft blood flow. While routinely performed by some bronchoscopists, the efficacy and safety profile of prophylactic administration of topical intrabronchial diluted epinephrine for the prevention of TBLB-related haemorrhage has not been explored in a prospective manner.Methods and analysisIn this randomised, double-blind, placebo-controlled multicentre trial (PROPHET Study), single-lung and double-lung transplant adult recipients from participating institutions who are scheduled for bronchoscopy with TBLB for clinical indications will be identified. Potential participants who meet inclusion and exclusion criteria and sign an informed consent will be randomised to receive either diluted epinephrine or placebo prior to performance of TBLB. The degree of TBLB-related haemorrhage will be graded by the performing bronchoscopist as well as independent observers. The primary analysis will compare the rates of severe and very severe bleeding in participants treated with epinephrine or placebo. The study will also evaluate the safety profile of prophylactic topical epinephrine including the occurrence of serious cardiovascular and haemodynamic adverse events. Additional secondary outcomes to be explored include rates of non-severe TBLB-related haemorrhage, overall yield of the bronchoscopic procedure and non-serious cardiovascular and haemodynamic adverse effects.Ethics and disseminationThe study procedures were reviewed and approved by institutional review boards in participating institutions. This study is being externally monitored, and a data and safety monitoring committee has been assembled to monitor patient safety and to evaluate the efficacy of the intervention. The results of this study will be published in peer-reviewed scientific journals and presented at relevant academic conferences.Trial registration numberNCT03126968; Pre-results.

show abstract

Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 8 publications

References 29 publications

A Non-inferiority Trial: Safety and Efficacy of Topical 1:1000 versus 1:10 000 Epinephrine in Sino-nasal Surgeries

A Non-inferiority Trial: Safety and Efficacy of Topical 1:1000 versus 1:10 000 Epinephrine in Sino-nasal Surgeries

Fast-track orthognathic surgery: An evidence-based review

Prophylactic epinephrine for the prevention of transbronchial lung biopsy-related bleeding in lung transplant recipients (PROPHET) study: a protocol for a multicentre randomised, double-blind, placebo-controlled trial

Contact Info

Product

Resources

About