Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan.
Rakuwakai Otowa Hospital, Kyoto, Japan.
Anesth Prog. 2022 Jun 1;69(2):38-40. doi: 10.2344/anpr-68-03-05.
We report a case of wide QRS tachycardia or ventricular tachycardia with a pulse after the administration of epinephrine under general anesthesia. After induction and achieving a sufficiently deep plane of general anesthesia, gauze soaked in a 1:100,000 epinephrine solution was applied to the patient's nasal mucosa and 1% lidocaine with 1:100,000 epinephrine was administered via intraoral infiltration. Several minutes after the start of surgery, the patient's blood pressure and heart rate suddenly increased and a wide QRS tachycardia was observed on the electrocardiogram, which then reverted to a normal sinus rhythm. According to the past reports, similar arrhythmias have occurred after administration of epinephrine in the head and neck. These findings suggest that anesthesia providers must be aware of the risks associated with epinephrine and local anesthetic use, particularly in the head and neck region.
我们报告一例在全身麻醉下应用肾上腺素后出现宽 QRS 心动过速或室性心动过速伴脉搏的病例。在诱导并达到足够深的全身麻醉平面后，将浸有 1:100000 肾上腺素溶液的纱布应用于患者的鼻腔黏膜，并通过口腔内浸润给予 1%利多卡因加 1:100000 肾上腺素。手术开始数分钟后，患者的血压和心率突然升高，心电图显示出现宽 QRS 心动过速，随后恢复为正常窦性节律。根据以往的报告，在头颈部应用肾上腺素后会出现类似的心律失常。这些发现表明，麻醉提供者必须意识到肾上腺素和局部麻醉药使用相关的风险，特别是在头颈部区域。
