Cardiovascular crisis after small dose local infiltration of epinephrine in patient with asymptomatic subarachnoid hemorrhage -A case report-

Abstract

The infiltration of dilute epinephrine solution has been used for many years to provide hemostasis. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced epinephrine-induced cardiovascular crisis, with severe hypertension, tachycardia, and cardiac arrest after subcutaneous infiltration of a 2% lidocaine and 1 : 200,000 epinephrine solution in a patient with an asymptomatic subarachnoid hemorrhage. We provided successfully advanced cardiac life support in the operating room and cardioverted the patient back into a sinus rhythm with no untoward effects. The patient recovered without any apparent sequelae after intensive care.

Changes in blood pressure and pulse rate of patients without systemic diseases following the injection of 2% lidocaine plus epinephrine 1:80000 in an inferior alveolar nerve block - A prospective study

“…However, such cardiovascular side effects are related to the concentration of anesthetic agents in circulation in a dose-dependent manner. [ 14 15 16 17 18 19 ] Therefore, the current study aims to examine whether the injection of 2% lidocaine with epinephrine 1:80000 for an inferior alveolar nerve block would change the cardiac indices such as blood pressure and pulse rate in patients without systemic diseases.…”

Coronary vasospasm caused by local infiltration of epinephrine after spinal anesthesia

“…Local infiltration of epinephrine at the surgical site has been widely used to improve the operating view, due to reduced blood loss caused by vasoconstriction [ 1 ]. However, the use of epinephrine can cause various adverse effects such as severe hypertension, ventricular arrhythmia, myocardial infarction, cardiomyopathy, cardiac arrest, and acute pulmonary edema [ 1 ].…”

“…Local infiltration of epinephrine at the surgical site has been widely used to improve the operating view, due to reduced blood loss caused by vasoconstriction [ 1 ]. However, the use of epinephrine can cause various adverse effects such as severe hypertension, ventricular arrhythmia, myocardial infarction, cardiomyopathy, cardiac arrest, and acute pulmonary edema [ 1 ]. Although there have been some cases of epinephrine-induced cardiovascular events with therapeutic intravenous administration or local infiltration under general anesthesia [ 1 , 2 , 3 , 4 , 5 ], there were no previous reports of coronary vasospasm following local infiltration of epinephrine after spinal anesthesia confirmed by immediate coronary angiography.…”

“…Although the patient in this case was injected with 1 mg of epinephrine mixed with normal saline SC, which can be regarded as a relatively safe dose for clinical use [ 1 , 2 ], epinephrine can be absorbed rapidly through cervical mucus where there is increased blood flow [ 4 ]. It has been known that using epinephrine diluted with lidocaine rather than with normal saline decreases the incidence of ventricular arrhythmias due to the protective effect of lidocaine on epinephrine [ 5 ].…”

“…We used esmolol for the treatment of epinephrine-induced tachyarrhythmia. Esmolol, a short-acting β1-selective blocker, can reduce the risk of hypertension and coronary spasm due to unopposed α-adrenergic stimulation, and it can be used to control catecholamine surges precisely [ 1 ].…”