Abstract No.: ABS2881: Comparison of cardiac indices using two different concentrations of adrenaline wicks during endoscopic trans-sphenoidal pituitary surgery: a prospective randomised observational study

BACKGROUND & AIMS: Trans-nasal trans-sphenoidal approach is preferred for surgical excision of pituitary tumours. Adrenaline is a generally usedvasoconstrictor for instillation or infiltration to decrease bleeding and improve the operative field quality. We aimed to compare the cardiac indices (Flotrac guided) and hemodynamic parameters while using two different doses of adrenaline for instillation METHODS: 60 ASA I/II patients, aged 18-65 years, undergoing transsphenoidal surgery for pituitary tumours were enrolled and allocatedto two groups. Group 1 received 1:200,000 concentration and Group 2 receiving 1:100,000 concentration of adrenalinetopically using cotton strips for 10-15 minutes. Cardiac indices and haemodynamic parameters were noted at baseline, every 5 minutes for first hour followed by every 10 minutes till the end of the procedure. Blood loss, quality of thefield and any adverse events were noted RESULTS: Significant reductions in cardiac indices (CO, CI) were noted in Group 2 at 60 and 70 minutes of the procedure compared to Group 1. There was no difference in haemodynamic parameters (HR, SBP, DBP, MAP, SPO2,) between the 1:100,000 and 1:200,000 adrenaline groups. However, hypertension and tachycardia were higher following instillation of 1:100,000 adrenaline concentration when compared with the baseline (p<0.005) CONCLUSION: 1:200,000 concentrations of adrenaline for nasal decongestion was associated with lowered cardiac indices compared to1:100,000 concentration. Field quality and usage of rescue drugs were comparable in both the study groups [Image: see text]