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Anesth Analg 1985; 64:924-928
© 1985 International Anesthesia Research Society
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Hemodynamic and Plasma Catecholamine Responses to Epinephrine-Containing Perianal Lidocaine Anesthesia

W. Byron Barber, MD, Lee E. Smith, MD, Gary P. Zaloga, MD, J. Raymond Fletcher, MD, PhD, David Cook, MD, C. Raymond Lake, MD, PhD, and Bart Chernow, MD, FACP

Department of Surgery, George Washington University Medical Center, Washington, DC; the Departments of Surgery, Critical Care Medicine, and Internal Medicine, Endocrinology-Metabolism Branch, Naval Hospital, Bethesda; the Naval Medical Research Institute; and the Departments of Medicine, Surgery, Pharmacology and Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Abstract

Despite the frequent use of large volumes (30–40 ml) of epinephrine-containing local anesthetic solutions for ano-rectal surgery, little is known about the anesthetic-induced hemdynamic consequences. Therefore, we measured the heart rate, blood pressure, and plasma catecholamine (norepinephrine and epinephrine) responses to the perianal injection of 40 ml of 0.5% lidocaine alone (n = 8) or 0.5% lidocaine with 1:200,000 epinephrine (n = 10) in 18 healthy adults undergoing outpatient ano-rectal surgery. The mean ± SFM plasma epinephrine concentration increased from a baseline of 42 ± 7 pg/ml to a peak of 622 ± 94 pg/ml 4 min after injection of epinephrine-containing anesthetic (P < 0.001), whereas lidocaine alone increased the mean plasma value from 36 ± 9 pg/ml (baseline) to only 69 ± 16 pg/ml (not significantly different) at its peak. Despite the increases in plasma epinephrine levels in the group receiving epinephrine-containing anesthesia, no changes in blood pressure, heart rate, or plasma norepinephrine levels were observed. Given the advantages (including prolongation of the duration of anesthesia) of adding epinephrine to perianal local anesthetics, our data support its safe use in healthy adults.

Key Words: ANESTHETIC TECHNIQUES, REGIONAL—infiltration • ANESTHETICS, LOCAL—lidocaine blood levels • SYMPATHETIC NERVOUS SYSTEM—epinephrine




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V. Souron and S. Sia
Plasma Concentrations of Epinephrine Need to Be Monitored in Study of Incidence of Hypotensive/Bradycardic Events * Response
Anesth. Analg., February 1, 2004; 98(2): 556 - 557.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1985 by the International Anesthesia Research Society.