Safety of Topical Epinephrine Compared with Oxymetazoline in Pediatric Functional Endoscopic Sinus Surgery: A Retrospective Cohort Study.

OBJECTIVE

To assess the safety of topical epinephrine during pediatric functional endoscopic sinus surgery (FESS).

METHODS

After obtaining IRB approval, electronic medical records of patients aged 0 to 14 undergoing FESS in 2021 were retrospectively reviewed and divided into 2 cohorts based on the topical vasoconstrictive agent utilized during the case: oxymetazoline or epinephrine. Patients without documentation of vasoconstrictor utilization or those who received both or neither vasoconstrictive agent were excluded. Outcome variables consisted of preoperative and maximum intraoperative heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, as well as administration of intraoperative propofol, fluids, and antihypertensive medications. Patients without documented preoperative HR, SBP, and DBP were additionally excluded from the study. Mean differences and adjusted mean differences were estimated using linear models adjusted for baseline.

RESULTS

Among a total cohort of 123 FESS patients, 57 met inclusion criteria and were primarily male (63%, n = 36) with a median age at procedure of 10.94 years (IQR 7.66, 13.31). Oxymetazoline was administered to 71.93% (n = 41) of the cohort, while 28.07% (n = 16) received epinephrine. The unadjusted and adjusted mean differences between all preoperative and intraoperative hemodynamic parameters were not significantly different between cohorts (P > .05 in all cases). No intraoperative antihypertensives were administered to patients in the study.

CONCLUSION

Topical epinephrine and oxymetazoline have similar risk profiles in pediatric functional endoscopic sinus surgery. A prospective study should be developed to evaluate the efficacy of topical epinephrine and to further assess its safety profile.