Junctional rhythm with severe hypotension following infiltration of lidocaine containing epinephrine during dental surgery

Younghoon Jeon; Jihye Shim; Hyunjee Kim

doi:10.17245/jdapm.2020.20.2.89

Junctional rhythm with severe hypotension following infiltration of lidocaine containing epinephrine during dental surgery

J Dent Anesth Pain Med. 2020 Apr;20(2):89-93. doi: 10.17245/jdapm.2020.20.2.89. Epub 2020 Apr 27.

Authors

Younghoon Jeon¹, Jihye Shim², Hyunjee Kim²

Affiliations

¹ Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea.
² Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

Abstract

We experienced an unusual case of accelerated junctional rhythm with severe hypotension after infiltration of lidocaine containing epinephrine during dental surgery under general anesthesia. The patient's electrocardiogram exhibited retrograde P-waves following the QRS complex, which could be misinterpreted as ST-segment depression. As a temporary measure, administration of ephedrine restored the patient's blood pressure to normal levels. The importance of this case lies in its demonstration of an unexpected and serious side effect of commonly used epinephrine infiltration. This case also highlights the need for accurate interpretation of the electrocardiogram and comprehensive understanding of best practices for patient management.

Keywords: Arrhythmia; Electrocardiography; Epinephrine; Hypotension.

Publication types

Case Reports