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Medical Forum / General / General / April 2004Epinephrine: Benign side effects compared to dangerous ones
I plan to soon have minor surgery under local that also requires epinephrine in the injection. I've heard of a few "bad reactions" to epi, but none that I know of were dangerous. One person claimed to have had shaking and freezing sensation for 5 minutes straight and another had "racing heart". I would think an uninformed patient would be alarmed at having such reactions, at least if it was the first time. What side effects from epi are harmless (although possibly disturbing) and which could be a sign of something dangerous occuring??? I think patients receiving epi, especially those not aware of how they will react to it, should be informed ahead of time and monitored if necessary while the epi takes effect. This is not for the purpose of "programming the patient" as all should hope for the best and use relaxation techniques while waiting for surgery but for us to be in the dark to this extent I think is wrong. I hope someone can end what for me is a big mystery about this medication. Any answers and suggestions are appreciated. Sherry > I plan to soon have minor surgery under local that also requires epinephrine > in the injection. I've heard of a few "bad reactions" to epi, but none that I [quoted text clipped - 10 lines] > someone can end what for me is a big mystery about this medication. Any > answers and suggestions are appreciated. Sherry My experience is with dental local anesthetics. The most common side effect is syncope or fainting. This usually only happens when the injection is inadvertently in a blood vessel. This goes along with the light-headedness, rapid, thready pulse, etc. In the doses usually used these are pretty trivial for a normal patient. A patient with a cardiac history esp. arrhythmia or uncontrolled high blood pressure should tell their doc--there are plenty of good anesthetics that contain no vasoconstrictors. They just diffuse from the surgical area more rapidly, so it is more likely that reinjection may be necessary. Steve Thanks for your rather uplifting answer. I do have "whitecoat" and treated "labile" HBP. I'm on monopril and generic microzide. I take BP regularly at home as well and it's usually not 120 but it's not usually 150 either. Strangely, the lower number is almost always a normal 75 to 85. I've never fainted and hope I never do. Just thinking I was going into that would be terrifying to me. The doctor apparently MUST use "epi". :/ I'm going to request being monitored by EKG or echo while the epi takes effect. Also I'll ask if he can use a bit less for me. Sherry It sounds to me like you're getting unnecessarily worked up about this. There's virtually *no* cardiovascular risk to receiving a local injection containing epinephrine, aside from inadvertant intravascular injection, which should never occur with proper technique. If you don't trust your doctor to do a good job, I suggest you find one who you do trust. Monitoring for local anesthesia is completely unnecessary. You could be monitored by EKG, pulse ox, BP, and have a paramedic standing over you with paddles in hand ready to defibrillate you at a moment's notice, but none of this will prevent you from passing out if you have a vagal episode or just plain get freaked out, which is basically what you're doing. > Thanks for your rather uplifting answer. I do have "whitecoat" and treated > "labile" HBP. I'm on monopril and generic microzide. I take BP regularly at [quoted text clipped - 5 lines] > request being monitored by EKG or echo while the epi takes effect. Also I'll > ask if he can use a bit less for me. Sherry > I plan to soon have minor surgery under local that also requires epinephrine >in the injection. I've heard of a few "bad reactions" to epi, but none that I [quoted text clipped - 10 lines] >someone can end what for me is a big mystery about this medication. Any >answers and suggestions are appreciated. Sherry I'm not aware of any conspiracy to keep people in the dark about epinephrine. The side effects of increased heartbeat and shaking are quite well known. It is an adrenaline substance and, as you probably know, adrenaline is critical to the "flight or fight" response to danger. It's often used in cases of respiratory distress and was one of the primary ingredients in Primatene mist. Those of us with high blood pressure or cardiovascular problems or respiratory problems should be monitored during the use of this drug, which I'm sure your doctor intends to do. > I'm not aware of any conspiracy to keep people in the dark about > epinephrine. > It's often used in cases of respiratory distress and was one > of the primary ingredients in Primatene mist. Was? You mean *is*. >> I'm not aware of any conspiracy to keep people in the dark about >> epinephrine. >> It's often used in cases of respiratory distress and was one >> of the primary ingredients in Primatene mist. > >Was? You mean *is*. Is Primatene mist still on the market? I thought it had been discontinued. > Is Primatene mist still on the market? I thought it had been > discontinued. It *should* be. Nope, it's still out there. See: http://www.primatene.com/products/index.asp >> Is Primatene mist still on the market? I thought it had been >> discontinued. > >It *should* be. Nope, it's still out there. See: >http://www.primatene.com/products/index.asp You're right. I had to stop at the drug store this a.m. on the way to work and it's sitting right there on the shelf. Thanks. |
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