Epinephrine hypersensitivity – induced cardiovascular crisis in otologic surgery

Intraoperative High-Dose Epinephrine Infiltration in Cleft Palate Repair

“…1 Lidocaine has a longer half-life than that of epinephrine (90Y120 min vs 2 min) and, therefore, maintaining the vasoconstriction of epinephrine through increased dosing can lead to lidocaine toxicity and cardiac complications. In addition to the distant effects of arrhythmia, tachycardia, hypertension, and pulmonary edema, epinephrine has been theorized to have local toxic effects such as tissue ischemia, increased wound infection rates, poorer wound healing, and decreased wound strength when overused.…”

“…1,8Y10 In addition, some physicians have cautioned against its overuse, and the recommended maximum dose of epinephrine in combination with lidocaine is 1 to 10 Kg/kg and no more than 100 Kg in any 10-minute period. 1 Epinephrine has been viewed as a tool for augmenting the effect of lidocaine by decreasing its toxicity and increasing the duration of the local anesthetic agent, whereas the reduction in blood loss has been seen as an ancillary benefit. 3 Aside from its role in potentiating lidocaine's activity, certain operations benefit instead from the strictly vasoconstrictive effects of epinephrine.…”

“…1 Typically, the dose of epinephrine is limited by the co-administration of local anesthetic as well as the risk for arrhythmogenesis and hemodynamic changes. Over time, these concerns have led many practitioners to question the safety of any large dose of epinephrine for local vasoconstriction and some controversy exists regarding the acceptable dose of epinephrine given to children.…”

Lungenödem und erosive Gastroduodenitis als Folge unsachgemäßer Anwendung eines Adrenalin-Dosisaerosols nach Wespenstich

“…[20] auf. Schließlich wurde ein Lungenödem sogar nach s.c. Gabe minimaler Adrenalindosen von 1 µg/kg im Rahmen einer Intubationsnarkose beobachtet [24].…”

“…Patienten mit vorbestehenden Hirngefäßerkrankungen ist die Provokation intrazerebraler Blutungen durch Adrenalin beobachtet worden, ferner gibt es Beschreibungen über das Auftreten von reaktiver Bradykardie und Hypotonie, Lungenödem und erosiver Gastritis als schwere Nebenwirkungen offensichtlich nicht situationsgerechten Einsatzes dieses Medikaments [11,13,21,24]. Schließlich kann die versehentliche Anwendung an den Akren Nekrosen zur Folge haben [12].…”