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Korean Journal of Anesthesiology 2007;52(5):591-595.
DOI: https://doi.org/10.4097/kjae.2007.52.5.591   
Acute Heart Failure Induced by a beta-blocker after the Local Infiltration of Epinephrine: A case report.
Ji Yeon Lee, Chong Hoon Kim, Sung Jin Lee, Na Hyung Jun, Wyun Kon Park
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. wkp7ark@yumc.yonsei.ac.kr
Topical epinephrine can cause severe hypertension, ventricular tachycardia, myocardial ischemia, cardiac arrest or pulmonary edema. The increased blood pressure and left ventricular afterload, as well as decreased left ventricular compliance caused by epinephrine may also decrease the cardiac output. If a beta blocker is used in these situations, the resulting decreased contractility and inability to increase the heart rate may further compromise the cardiopulmonary function. A 26 year-old man developed tachycardia and hypertension following the local infiltration of epinephrine 2 ml (1:10,000) around the nasal mucosa and an intramucosal injection of epinephrine 7.2 ml (1:100,000). He was treated with intravenous esmolol 10 mg. He showed a decreasing heart rate and blood pressure, depressed ST segments and inverted T waves. At the same time, the pulsation of the femoral arteries was not palpable. Cardiac massage was started. He was treated with intravenous atropine 0.5 mg and epinephrine 5microgram. He recovered from circulatory failure after this treatment and his ECG showed a normal sinus rhythm.
Key Words: electromechanical dissociation; epinephrine; esmolol


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