A Case of Wide QRS Tachycardia After the Local Administration of Epinephrine to Reduce Bleeding During General Anesthesia

We report a case of wide QRS tachycardia or ventricular tachycardia with a pulse after the administration of epinephrine under general anesthesia. After induction and achieving a sufficiently deep plane of general anesthesia, gauze soaked in a 1:100,000 epinephrine solution was applied to the patien...

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Bibliographic Details
Published in:Anesthesia progress 2022-06, Vol.69 (2), p.38-40
Main Authors: Usami, Nayuka, Tooyama, Midori, Oda, Wakana, Kawamoto, Yuu, Kishimoto, Saki, Minamide, Ayano, Niwa, Hitoshi
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesiology
Angina pectoris
Blood pressure
Brief Communications from the Japanese Dental Society of Anesthesiology
Cardiac arrhythmia
Case reports
EKG
Electrocardiography
Epinephrine
Fentanyl
General anesthesia
Head and neck
Heart rate
Lidocaine
Patients
Surgery
Tachycardia
Ventricle
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Summary:We report a case of wide QRS tachycardia or ventricular tachycardia with a pulse after the administration of epinephrine under general anesthesia. After induction and achieving a sufficiently deep plane of general anesthesia, gauze soaked in a 1:100,000 epinephrine solution was applied to the patient's nasal mucosa and 1% lidocaine with 1:100,000 epinephrine was administered via intraoral infiltration. Several minutes after the start of surgery, the patient's blood pressure and heart rate suddenly increased and a wide QRS tachycardia was observed on the electrocardiogram, which then reverted to a normal sinus rhythm. According to the past reports, similar arrhythmias have occurred after administration of epinephrine in the head and neck. These findings suggest that anesthesia providers must be aware of the risks associated with epinephrine and local anesthetic use, particularly in the head and neck region.
ISSN:0003-3006
1878-7177
DOI:10.2344/anpr-68-03-05