title: Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases.
abstract: Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Hee-Won
authors.identifier: 0000-0002-8035-062X
authors.initials: HW
authors.lastname: Son
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Se-Hun
authors.identifier: 0000-0003-2264-4627
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Hyun-Oh
authors.identifier: 0000-0002-7047-8048
authors.initials: HO
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Yong-Joon
authors.identifier: 0000-0002-9189-9335
authors.initials: YJ
authors.lastname: Shin
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Jang-Ho
authors.identifier: 0000-0002-9681-3561
authors.initials: JH
authors.lastname: Son
keywords: Epinephrine; Lactic acidosis; Local anesthesia; Orthognathic surgery; Topical administration