Murakawa T, Koh H, Tsubo T, Ishihara H, Matsuki A
Department of Anesthesiology, Odata Municipal Hospital.
Masui. 1998 Aug;47(8):955-62.
We experienced two cases of circulatory failure after local infiltration of 0.0005% epinephrine solution for the purpose of prophylactic hemostasis during tonsillectomy under sevoflurane anesthesia. Case 1: A 14 year-old girl developed ventricular bigeminy, tachycardia and hypertension following infiltration of the epinephrine solution 6ml around the tonsil. Sinus rhythm returned with intravenous lidocaine 40 mg and propranolol 0.4 mg. However, the patient showed gradually decreasing heart rate, depressed ST segments and inverted T waves and poor peripheral circulation. Her blood pressure decreased abruptly at the same time and finally the pulsation of the radial and femoral arteries was not palpable. She was treated with intravenous ephedrine in vain. Therefore, she received intravenous epinephrine and cardiac massage, and then recovered from the circulatory failure with her ECG showing normal sinus rhythms. Emergence from the anesthesia was smooth. Her cardiac failure may have been caused by the decreasing cardiac contraction and the increasing afterload due to the vasoconstriction after the intravenous beta-blocker. Case 2: An eleven year-old boy showed ventricular tachycardia and hypertension after infiltration of the epinephrine solution 11.5 ml around the tonsil. Lidocaine was given intravenously. This restored sinus rhythm but the ST segments on his ECG were elevated. ST segments became normalized after intravenous nitroglycerin. However, pulmonary edema developed suddenly, and it was cured by intensive treatment. His ventricular tachycardia and hypertension after the local administration of epinephrine were presumably responsible for the acute heart failure causing the pulmonary edema. Our experience suggests that the maintenance of cardiac function and the reduction of afterload are important to overcome the circulatory disaster following the local infiltration of epinephrine.
在七氟醚麻醉下行扁桃体切除术时，为预防性止血局部浸润0.0005%肾上腺素溶液后，我们遇到了两例循环衰竭的病例。病例1：一名14岁女孩在扁桃体周围浸润6ml肾上腺素溶液后出现室性二联律、心动过速和高血压。静脉注射40mg利多卡因和0.4mg普萘洛尔后恢复窦性心律。然而，患者心率逐渐下降，ST段压低，T波倒置，外周循环不良。同时她的血压突然下降，最终桡动脉和股动脉搏动触不到。静脉注射麻黄碱治疗无效。因此，她接受了静脉注射肾上腺素和心脏按压，随后从循环衰竭中恢复，心电图显示窦性心律正常。麻醉苏醒顺利。她的心力衰竭可能是由于静脉注射β受体阻滞剂后血管收缩导致心脏收缩力下降和后负荷增加所致。病例2：一名11岁男孩在扁桃体周围浸润11.5ml肾上腺素溶液后出现室性心动过速和高血压。静脉注射利多卡因。这恢复了窦性心律，但他心电图上的ST段抬高。静脉注射硝酸甘油后ST段恢复正常。然而，突然发生肺水肿，经强化治疗治愈。他局部应用肾上腺素后的室性心动过速和高血压可能是导致急性心力衰竭进而引起肺水肿的原因。我们的经验表明，维持心脏功能和降低后负荷对于克服肾上腺素局部浸润后的循环灾难很重要。
