Cardiovascular and metabolic effects of cervical epinephrine infiltration

Ventricular arrhythmia may follow the infiltration of dilute, epinephrine-containing solutions to achieve hemostasis during surgery. The objective of this study was to determine the cardiovascular and metabolic changes associated with the infiltration of 1.5 micrograms/kg epinephrine 1:200,000 in 0.5% lidocaine into the cervix of patients having a cervical cone biopsy under epidural anesthesia. These observations were compared with a control group who were infiltrated with 0.5% plain lidocaine under similar epidural anesthesia during cone biopsy. In the epinephrine-treated group, marked heart rate, rhythm, and systolic/diastolic blood pressure changes from baseline values were observed as well as significant glycogenolysis, lactic acidosis, and hypokalemia. Based on these observations, the total dose of injected epinephrine should be less than 1 microgram/kg; the solution should be diluted to 1:400,000 concentration, and the injection, after careful aspiration, should be performed over at least five minutes into the less vascular anterior and posterior cervix sites.