Epinephrine Hypersensitivity—Induced Cardiovascular Crisis in Otologic Surgery

Optimal Concentration of Epinephrine for Vasoconstriction in Ear Surgery

“…Epinephrine's use is not without potential toxicity, however, and dose‐dependent reactions of hypertension, arrhythmia, and pulmonary edema have been described. 1 The minimum epinephrine dose to give adequate hemostasis while minimizing toxicity for otologic surgery has yet to be determined.…”

“…Subsequently, pulmonary edema developed from 3 and 8 mL, respectively, of 1:100,000 epinephrine infiltrated in standard fashion at the beginning of the case. 1 Rooke and Milne reported a case of pulmonary edema in a patient with renal failure after a total of 125 μg of subcutaneous epinephrine. 5 …”

“…This risk is highlighted by a report by Wanamaker et al in which they described two cases of cardiovascular crisis during otologic surgery on adolescents secondary to extreme sensitivity to subcutaneously administered epinephrine. 1 Toxicity includes hypertension, ventricular arrhythmia, and pulmonary edema that are potentiated by some inhalational anesthetics. Being more susceptible to apneas and arrhythmia, infants are at risk for dramatic exacerbation of epinephrine's cardiovascular effects.…”

Optimal Concentration of Epinephrine for Vasoconstriction in Neck Surgery

“…The dose at which these interactions become significant has been disputed. The maximum dosage of epinephrine in healthy patients varies from 1 to 10 μg/kg with no more than 100 μg given in any 10‐minute period(10 mL of a 1:100,000 solution) 1 …”

“…Epinephrine has become the gold standard for vasoconstriction, but is has limitations due to its potential cardiac and local toxic effects. Cardiac toxicities include arrhythmias, tachycardia, hypertension, and pulmonary edema that are potentiated by the use of hydrocarbon anesthetics 1 . The local toxic effects are delayed healing, reduced wound tensile strength, skin necrosis, and increased infection rates 2‐4 .…”