Hazards of epinephrine in transsphenoidal pituitary surgery

A 79-year-old woman with no history of myocardial ischemia presented with symptoms of pituitary apoplexy for which an urgent transsphenoidal resection of the pituitary gland was undertaken. The nasal passages were prepared with topical application of epinephrine followed by injection of what was presumed to be 1% lidocaine containing 10 microg/ml(-1) of epinephrine. After only 1.5 mL of the solution had been injected, she developed a hypertensive crisis, which was immediately treated. Postoperatively, she developed a myocardial infarction. The risks associated with the use of vasopressors are reviewed and suggestions for their safe use are presented.