Effects of Nasal Application of an Epinephrine and Lidocaine Mixture on the Hemodynamics and Nasal Mucosa in Oral and Maxillofacial Surgery

Kameyama, Kimiko; Watanabe, Seiji; Kano, Tatsuhiko; Kusukawa, Jingo

doi:10.1016/j.joms.2008.01.013

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Volume 66, Issue 11 , Pages 2226-2232, November 2008

Effects of Nasal Application of an Epinephrine and Lidocaine Mixture on the Hemodynamics and Nasal Mucosa in Oral and Maxillofacial Surgery

Kimiko Kameyama, DDS
- Assistant Professor, Department of Anesthesiology, and the Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Address correspondence and reprint requests to Dr Kameyama: Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
Seiji Watanabe, MD, PhD
- Associate Professor, Department of Anesthesiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
Tatsuhiko Kano, MD, PhD
- Chairperson and Professor, Department of Anesthesiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
Jingo Kusukawa, DDS, PhD
- Professor, Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan

Purpose

Our purpose was to investigate the influences of nasal pretreatment with a mixed solution of epinephrine and lidocaine (E-L pretreatment) on the systemic hemodynamics and the mucosa of the inferior nasal concha, which is carried out for expansion of the nasal cavity and the prevention of mucosal injury before nasotracheal intubation.

Patients and Methods

Subjects included 29 adult patients undergoing oral and maxillofacial surgery. This study consisted of 2 parts. In part 1 (n = 18), the effects of E-L pretreatment on the systemic hemodynamics were studied before (pre-Anesth group, n = 10) and after (post-Anesth group, n = 8) induction of anesthesia. Changes of the mucosal volume and the blood flow of the inferior nasal concha also were observed by optic bronchoscopy and noncontact type laser-Doppler flowmetry, respectively. In part 2 (n = 11), changes in the serum concentrations of epinephrine and lidocaine after the E-L pretreatment were determined by high performance liquid chromatography and enzyme immunoassay, respectively.

Results

The heart rate increased at 2 and 3 min after E-L pretreatment in pre-Anesth group (P < .05), but not in post-Anesth group. The cross section of the nasal cavity decreased from 66% to 42% (n = 8, P < .05). The mucosal blood flow decreased from 60 to 22 AU (n = 8, P < .01). The serum epinephrine concentration increased from 24 to 185 pg/mL.

Conclusions

The E-L pretreatment provided characteristic evidence for useful expansion of the nasal cavity and for reduction of the nasal mucosal blood flow with less systemic hemodynamic effects, although further investigation is needed for the determination of the proper epinephrine concentration in E-L pretreatment.