Key Points
- To report a case of acute pulmonary edema and cardiac arrhythmia triggered by local epinephrine infiltration during a pediatric tonsillectomy.
- Clinical case evaluation of a 10-year-old patient undergoing tonsillectomy with local anesthetic and epinephrine infiltration.
- Monitoring of cardiovascular adverse events and assessment of therapeutic management including fluid management, inotropes, and oxygen therapy.
- Local infiltration of epinephrine precipitated acute ventricular premature contractions and severe acute pulmonary edema.
- Intensive management with fluid restriction, diuretics, dobutamine infusion, and 5 L/min oxygen by mask led to full recovery without neurological or cardiopulmonary sequelae.
Structured PICO
PPopulation10-year-old patient undergoing tonsillectomy
IInterventionLocal epinephrine infiltration
OOutcomeDevelopment of acute pulmonary edema and ventricular premature contractionsafety
Local epinephrine infiltration during tonsillectomy can cause severe cardiovascular complications such as acute pulmonary edema and arrhythmias in pediatric patients.