Regarding the use of Adrenaline solution in surgery (combustiology) for skin burns: a literature review

Based on the analysis of the literature and our own experience, the data on the use of adrenaline 0.1% solution as a vasoconstrictor for topical application during surgical treatment of burned patients are systematized. In surgery-combustiology, adrenaline is used in the following clinical cases: subcutaneous administration for hemostasis of the donor site after graft taking by dermatome;subcutaneous injection of the drug under necrotic tissues for hemostasis in necrectomies; local applications of bandages with adrenaline solution in diffuse bleeding. In the literature there is information about the hemostatic effect of adrenaline with its subcutaneous administration. It is important to remember that the maximum permissible single dose of adrenaline for adults with subcutaneous injection is 1 ml. Complications with the use of this drug can include a list of serious nosologies, up to the development of tissue necrosis, heart rhythm disturbances, lethal outcome. It is believed that the leading cause of such complications is the systemic action of the drug, incorrect calculation of the drug dose, peculiarities of the general condition of the body, concomitant use of a number of drugs, in particular narcotic analgesics. Vasoconstrictor effect of adrenaline leads to prolonged tissue ischemia, local use of anesthetic drugs together with adrenaline can lead to ischemia and necrosis of distal parts of the extremities, in particular fingers. A significant impact on the incidence of complications during adrenaline administration is caused by conditions associated with blood coagulation disorders, liver diseases, coagulopathies of various genesis, vascular changes. When using adrenaline solution it is necessary to intraoperatively monitor blood pressure and pulse. In case of tachycardia and increased pressure, it is necessary to suspend the use of the drug without waiting for the development of serious consequences. Specialists proposed the calculation of the volume of 0.9% sodium chloride solution with adrenaline in the preparation of the donor site before the skin split graft, the excess of which can lead to general complications. 2500 mL is the maximum amount of saline solution when administered at 2 drops of adrenaline per 250 mL when the preparation is administered subcutaneously. There is no unanimous opinion among combustiologists about indications and contraindications, dosage calculation, methods of administration, probability of complications development.