Key result
Local mucosal epinephrine during general anesthesia linked to transient wide QRS tachycardia with a pulse.
Case Report (n=1)
Local administration of epinephrine in the head and neck region during general anesthesia can trigger wide QRS tachycardia, highlighting the need for vigilance by anesthesia providers.
Epinephrine mucosal application under general anesthesia can provoke transient wide QRS tachycardia; this case leaves open broader risk assessment.
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.
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Usami et al. (2022) conducted a case report in Malignant gingival tumor (squamous cell carcinoma) (n=1). Epinephrine was evaluated on Development of wide QRS tachycardia. Local administration of epinephrine to the nasal and oral mucosa during general anesthesia induced a transient episode of wide QRS tachycardia with a pulse.
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