title: The interaction between propranolol and epinephrine as observed in patients undergoing Mohs' surgery.
abstract: The blood pressure response to the administration of epinephrine-containing local anesthetics was studied prospectively in ten patients taking propranolol and in ten control patients. While no significant alteration in blood pressure was documented for the patients taking propranolol, the blood pressures of the control group tended to decrease following injection of anesthetic. The variation in blood pressure response between the two groups was statistically significant and represents a mild manifestation of the blockade of beta-2 receptors of the vascular beds from the propranolol. The uncommon occurrence of a malignant hypertensive response from a propranolol-epinephrine reaction is probably a dose-related, somewhat idiosyncratic sensitivity of the peripheral vasculature to the alpha pressor effect of epinephrine unmasked by the blockade of beta receptors. The risk of this catastrophic event must be weighed against the risk of precipitating a myocardial ischemic event from too rapid an alteration in propranolol dosage. Malignant hypertension is probably uncommon in patients receiving low doses of epinephrine during most dermatologic procedures.
mesh_terms: D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects*; D004347:Drug Interactions; D004837:Epinephrine / Q000494:pharmacology*; D006801:Humans; D011433:Propranolol / Q000494:pharmacology*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000601:surgery
chemical_list: D011433:Propranolol; D004837:Epinephrine