Cardiac failure following inadvertent administration of high-dose epinephrine subcutaneously

Abstract

Our aim is to report the consequences of epinephrine toxicity leading to cardiac failure in a child and the successful management with dopamine and milrinone. A previously healthy 13-year-old girl undergoing a left tympanomastoidectomy was inadvertently administered 10 mL of 1:1000 epinephrine subcutaneously (0.175 mg/kg) on the left post auricular region in lieu of lidocaine. She developed sudden supraventricular tachycardia, hypertension and flash pulmonary edema. She was initially treated with propofol, nitrogycerin and increased peak end-expiratory pressure. Within 4 h, she remained tachycardic, but was hypotensive with an increased central venous pressure. Electrocardiogram and echocardiogram investigations showed ST changes indicative of myocardial ischemia and globally reduced function, respectively. Dopamine infusion was administered, together with milrinone, resulting in a gradual improvement of cardiac function within 3 days. She was transitioned to enalapril and discharged home. This case highlights the clinical features of high dose epinephrine toxicity secondary to iatrogenic subcutaneous overdose followed by hypotension and pulmonary edema as a possible late effect of epinephrine and the successful management of secondary cardiac failure with administration of dopamine, milrinone and enalapril.

Myocardial protection induced by fentanyl in pigs exposed to high‐dose adrenaline

“…Gasometry was performed using an ABL555 blood gas analyser (Radiometer America, Westlake, OH, USA). Lung compliance and airway pressure were measured continuously and recorded from anesthesia workstation (Primus Dr€ ager) at baseline and at 5,10,15,20,25,30,40,50, 60, 90, 120, 150, 180, 210, 240, 300, 330 and 360 min. The pulmonary shunt and AaDO 2 were calculated using standard formulae 50 (Fig.…”

“…Few studies have described the sole effects of high doses of adrenaline on normal myocardium, demonstrating that it is a cause of myocardial dysfunction, and possibly mortality. 5,[10][11][12][13] Any effort made to attenuate or block myocardial dysfunction following high-dose catecholamine may have an effect on patient mortality. 13 Experimental models have demonstrated the potential cardioprotective effects of fentanyl and other opioids acting through anti-arrhythmic and anti-ischaemic mechanisms, [14][15][16][17][18] notably via activation of d 15,17 and j 19 opioid receptors.…”