[Effect of lidocaine-epinephrine-dextran solution on the plasma epinephrine concentration during spinal surgery--how to avoid circulatory complications due to the use of epinephrine for hemostasis].
Epinephrine infiltrated for hemostasis may cause adverse effect on the circulatory system and the effect can be potentiated by surgical stimulation. Local infiltration of lidocaine-epinephrine-dextran solution (LED) at the surgical site is advantageous for this purpose since nerve blocking action of lidocaine attenuates surgical stimulation and dextran suppresses the transfer of injected epinephrine to the blood stream, thereby reducing the adverse effect of epinephrine. LED, however, could be injected accidentally into vessels. This is one of the important causes of raising the plasma epinephrine concentration to a dangerous level. The author believes that the following maneuvers are helpful to avoid the rise of plasma epinephrine concentration to a dangerous level; 1) injecting not more than 0.05 ml.kg-1 at a time, 2) monitoring the arterial pressure waves and ECG during the injection by use of a continuous recording device, and 3) halting the injection immediately whenever sudden changes in the arterial pressure and in the height of the T wave in ECG were observed. More importantly, surgeon's cooperation is essential for anesthesiologists to execute these maneuvers.
Ueda
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Department of Anesthesiology & Resuscitology, Kochi Medical School, Nankoku.
D000328:Adult; D003911:Dextrans / Q000008:administration & dosage*; D004837:Epinephrine / Q000009:adverse effects / Q000097:blood*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D013131:Spine / Q000601:surgery*
D003911:Dextrans; D008012:Lidocaine; D004837:Epinephrine