Severe transient hypertension after greater palatine foramen block in a patient taking midodrine.
We report an episode of transient, severe hypertension occurring within 2 minutes of injection of 1% lidocaine with 1:100,000 U of epinephrine in a patient taking midodrine for orthostatic hypotension. We hypothesize that the patient's autonomic nervous system was dangerously susceptible to the effect of local anesthetic when combined with the vasoactive systemic effect of midodrine. Surgeons should minimize the use of vasoconstrictors in patients treated with midodrine to avoid hypertensive complications.
Rizzi
Mark D
MD
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Weil
Robert J
RJ
Lorenz
Robert R
RR
D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D004837:Epinephrine / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007016:Hypophysectomy; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000009:adverse effects*; D014066:Palatine Tonsil; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008879:Midodrine; D008012:Lidocaine; D004837:Epinephrine