Key result
Intravenous ephedrine induces repeated HR reductions in a patient possibly driven by simultaneous remifentanil.
Case Report (n=1)
Intravenous ephedrine may paradoxically induce a decrease in heart rate, potentially due to simultaneous administration of remifentanil.
Ephedrine may paradoxically slow heart rate with remifentanil; single case leaves open interaction prevalence and clinical relevance.
Ephedrine is a sympathomimetic agent with α1, β1, and β2 adrenergic-receptor effects inducing hypertension and tachycardia. It has direct post-synaptic adrenergic receptor agonism and indirect action by competitively inhibiting nor-adrenaline reuptake by synaptic vesicles at sympathetic nerve terminals, thus increasing its local concentration. We describe a case of a 35-year-old male, American Society of Anesthesiologists (ASA) physical status class II, undergoing right mastoidectomy for recurrent right post-auricular abscess, who developed repeated reduction in heart rate, each time after receiving an intravenous ephedrine bolus (6–9 mg/bolus). One of the possible reasons could be the simultaneous push of remifentanil during each bolus.
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Karmakar et al. (2025) conducted a case report in Recurrent right post-auricular abscess (n=1). Intravenous ephedrine was evaluated on Reduction in heart rate. Intravenous ephedrine boluses (6-9 mg) induced repeated reductions in heart rate in a 35-year-old male, possibly due to simultaneous remifentanil administration.
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