[Circulatory disaster following infiltration of epinephrine contained in local anesthetic]

There are many case reports regarding unexpected circulatory responses such as hypertension, dysarrythmias, pulmonary edema and catecholamine myopathy, following infiltration of epinephrine into surgical fields. These cases occurred under general anesthesia, whereas we report a case which occurred with local anesthetic use only, with manifested severe circulatory system response to a small dose of epinephrine administered with lidocaine. The case is a 53 year old female with tongue cancer. A skinflap of the formerly operated tongue was infiltrated with 4 ml of 0.5% lidocaine and 0.0005% epinephrine for local anesthesia and hemostasis prophylaxis. Soon thereafter, the patient developed ventricular tachycardia, severe hypertension and pulmonary edema, but was treated successfully. It is important to recognize the risk of severe circulatory system response which may be elicited by a small dose of epinephrine contained in local anesthetics whether under general anesthesia or not.