Intraoperative ventricular fibrillation arrest caused by accidental intravenous injection of epinephrine

We describe a 25-year old male who experienced ventricular fibrillation (V-Fib) arrest induced by inadvertent intravenous injection of epinephrine instead of the routine reversal medication. Under general anesthesia with Desflurane inhalation, 1.5% Lidocaine containing 1:100,000 Epinephrine was injected into the nasal mucosa for septoplasty and the procedure went smoothly. Near the end of the surgery, the patient suddenly developed sinus tachycardia followed by V-Fib arrest which responded to a single shock of 300J. Sinus rhythm was restored immediately. The patient developed severe lactic acidosis and a bedside echocardiography showed global hypokinesia and normal right sided pressures. The patient was intubated and admitted to the ICU on mechanical ventilation before being weaned and extubated. Retrospectively while investigating the cause after it was discovered that epinephrine had been given as opposed to the anesthesia reversal medication. This case illustrates an unusual response to epinephrine with cardiac arrest in a healthy young male.