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2.
Am J Case Rep ; 22: e930889, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33879760

RESUMO

BACKGROUND Clostridial myonecrosis, also known as gas gangrene, is a highly lethal necrotizing soft tissue infection. While commonly associated with trauma, clostridial myonecrosis may be the result of parenteral injection of medications. Epinephrine is the most commonly reported medication leading to gas gangrene. CASE REPORT A 60-year-old man presented to the Emergency Department (ED) with "the worst pain in his life" to the right thigh near the site at which he auto-injected epinephrine after multiple bee stings 10-11 h prior to arrival. Initial heart rate was 112 beats/min but all other vital signs were unremarkable at presentation. Due to extreme pain, a computed tomography (CT) scan was ordered, revealing prominent gas within the anterior compartment of the right thigh, mostly involving the vastus lateralis and rectus femoris, suggesting necrotizing fasciitis. Antimicrobials were initiated immediately and the patient was taken for surgical debridement within 70 min after obtaining the CT results. Clostridium perfringens was cultured from the patient's tissue. After several surgical debridement's, appropriate antimicrobial therapy, supportive care, and wound care, the patient's limb remained intact and he was discharged after 11 days. CONCLUSIONS With millions of epinephrine auto-injectors prescribed yearly in the United States, awareness of clostridial gas gangrene following epinephrine auto-injection for the provider may help guide decision-making in patients presenting with extreme pain, redness, or swelling near the injection site after epinephrine injection.


Assuntos
Desbridamento , Epinefrina/administração & dosagem , Gangrena Gasosa/etiologia , Hipersensibilidade , Mordeduras e Picadas de Insetos/terapia , Perna (Membro)/diagnóstico por imagem , Animais , Antibacterianos/uso terapêutico , Abelhas , Clostridium perfringens/isolamento & purificação , Epinefrina/efeitos adversos , Gangrena Gasosa/terapia , Humanos , Injeções Subcutâneas , Masculino , Tomografia Computadorizada por Raios X
3.
Anesth Prog ; 68(1): 10-18, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827126

RESUMO

The objectives of this research were to investigate (a) what was the most effective infusion rate of remifentanil and (b) the degree to which sympathomimetic effects were involved with cardiovascular stimulation by using a power spectral analysis of heart rate variability (HRV). A total of 63 healthy individuals scheduled for sagittal split ramus osteotomy were enrolled and randomly allocated to 1 of 3 groups: remifentanil infusion rate of 0.1, 0.2, or 0.4 µg/kg/min. Anesthesia was maintained with remifentanil and propofol. Before the surgical procedure, 2% lidocaine containing 12.5 µg/mL epinephrine was administered in the surgical field for local anesthesia. Systolic blood pressure (SBP), heart rate (HR), low-frequency (LF) and high-frequency (HF) components in HRV power spectral analysis, and the LF/HF ratio were analyzed. Increases in SBP and HR were observed after local anesthesia in all 3 groups, but no significant differences were observed between the groups. Remifentanil infusion at 0.1 µg/kg/min may be appropriate to minimize cardiovascular stimulation caused by exogenous epinephrine from local anesthesia. Although a rise in the LF/HF ratio was observed after local anesthesia in all groups, no relationship was observed between the cardiovascular changes and the increase in LF/HF ratio. This suggests that sympathomimetic effects are involved to a lesser extent with the cardiovascular stimulation caused by exogenous epinephrine.


Assuntos
Anestesia Local , Anestésicos Locais , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/efeitos adversos , Pressão Sanguínea , Epinefrina/efeitos adversos , Frequência Cardíaca , Humanos , Piperidinas/efeitos adversos , Remifentanil/farmacologia
4.
Anesth Prog ; 68(1): 38-44, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827129

RESUMO

There are numerous causes of cardiac arrest in the perioperative period, including hypoxia, hypovolemia, and vagal response to medications or procedures during routine anesthetics. Initiation of adequate cardiopulmonary resuscitation, administration of epinephrine, and application of a defibrillator, with shocking when applicable, are all essential steps in achieving return of spontaneous circulation. Knowledge and utilization of monitoring equipment can alert the provider to problems leading to cardiac arrest as well as ensure proper resuscitative efforts during the event. Polypharmacy is quite common with many of today's special needs patients. It is important to understand the medications they are taking as well as the potential interactions that may occur with drugs given during sedation and general anesthesia. The following is a case report of cardiac arrest including asystole and pulseless electrical activity in a 27-year-old man with autism and behavioral problems who presented for restorative dentistry under general anesthesia in the ambulatory surgery setting.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Adulto , Anestesia Geral/efeitos adversos , Epinefrina/efeitos adversos , Parada Cardíaca/induzido quimicamente , Humanos , Masculino
5.
BMJ Case Rep ; 14(3)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33753391

RESUMO

A 26-year-old woman developed acute compartment syndrome (ACS) of her right hand secondary to reperfusion syndrome. She suffered an out-of-hospital cardiac arrest following a pregabalin overdose. Attending paramedics mistakenly gave intra-arterial epinephrine into her right brachial artery. On resolution of her brachial artery spasm, she developed a reperfusion injury to her right hand and subsequently ACS. A four-incision fasciotomy with carpal tunnel decompression was performed and was successful in reversing focal ischaemia and an irreversible functional deficit. This case demonstrates an unusual case of hand ACS secondary to temporary limb ischaemia and reperfusion syndrome following iatrogenic intra-arterial epinephrine administration. We also summarise the current available literature on ACS of the hand including the aetiology, treatment and use of an intracompartmental monitor.


Assuntos
Reanimação Cardiopulmonar , Síndromes Compartimentais , Adulto , Síndromes Compartimentais/induzido quimicamente , Síndromes Compartimentais/cirurgia , Epinefrina/efeitos adversos , Feminino , Mãos , Humanos , Doença Iatrogênica
6.
Anesth Analg ; 132(4): 1129-1137, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33464760

RESUMO

BACKGROUND: Bupivacaine and ropivacaine are the preferred long-acting local anesthetics for peripheral nerve blocks as they provide prolonged analgesia in the postoperative period. No studies have directly compared the analgesic duration of these commonly used local anesthetics in the setting of low-volume ultrasound-guided interscalene block (US-ISB). This study was designed to determine which local anesthetic and concentration provides superior analgesia (duration and quality) for low-volume US-ISB. METHODS: Sixty eligible patients scheduled for arthroscopic shoulder surgery were randomized (1:1:1) to receive US-ISB (5 mL) with 0.5% bupivacaine with 1:200,000 epinephrine, 0.5% ropivacaine, or 1% ropivacaine. All individuals were blinded including study participants, anesthesiologists, surgeons, research personnel, and statistician. All participants received a standardized general anesthetic and multimodal analgesia. The primary outcome was duration of analgesia defined as the time from the end of injection to the time that the patients reported a significant increase in pain (>3 numeric rating scale [NRS]) at the surgical site. RESULTS: The mean duration of analgesia for 0.5% bupivacaine with 1:200,000 epinephrine, 0.5% ropivacaine, or 1% ropivacaine was 14.1 ± 7.4, 13.8 ± 4.5, and 15.8 ± 6.3 hours, respectively (analysis of variance [ANOVA], P = .51). There were no observed differences in analgesic duration or other secondary outcomes between the 3 groups with the exception of a difference in cumulative opioid consumption up to 20h00 on the day of surgery in favor of ropivacaine 0.5% over bupivacaine of minimal clinical significance. CONCLUSIONS: In the context of single-injection low-volume US-ISB, we have demonstrated a similar efficacy between equal concentrations of ropivacaine and bupivacaine. In addition, increasing the concentration of ropivacaine from 0.5% to 1% did not prolong the duration of US-ISB.


Assuntos
Agonistas Adrenérgicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção , Agonistas Adrenérgicos/efeitos adversos , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/efeitos adversos , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Bupivacaína/efeitos adversos , Epinefrina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Ontário , Medição da Dor , Limiar da Dor/efeitos dos fármacos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Ropivacaina/efeitos adversos , Articulação do Ombro/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461998

RESUMO

Orbital complications after endoscopic sinus surgery are serious problems. Inadvertent contamination of the eye by pharmacological solution can lead to early postoperative anxiety to patients and high concern to surgeons. This is a rare case report of retrograde epinephrine flow through lacrimal duct in sinus surgery with learning tips during postoperative assessment for reassurance in temporary pharmacological effect rather than serious complication.


Assuntos
Agonistas alfa-Adrenérgicos/efeitos adversos , Epinefrina/efeitos adversos , Midríase/induzido quimicamente , Seios Paranasais/cirurgia , Complicações Pós-Operatórias/induzido quimicamente , Adolescente , Feminino , Humanos , Aparelho Lacrimal , Midríase/diagnóstico , Complicações Pós-Operatórias/diagnóstico
8.
Plast Reconstr Surg ; 146(1): 54e-60e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590653

RESUMO

BACKGROUND: The wide-awake local anesthesia no tourniquet (WALANT) technique in hand surgery is gaining popularity. The authors aimed to prospectively analyze the frequency and type of arrhythmias in patients undergoing hand surgery under local anesthesia and to examine whether the addition of adrenaline affects their incidence. METHODS: Adult patients undergoing hand surgery under local anesthesia were randomized into two groups: group 1, local anesthesia with lidocaine and tourniquet; and group 2, local anesthesia with lidocaine and adrenaline (WALANT). Patients with a history of arrhythmias were excluded. Patients were connected to Holter electrocardiographic monitoring before surgery and up until discharge. The records were blindly compared between the groups regarding types of arrhythmias, and frequency and timing relative to injection and tourniquet inflation. RESULTS: One hundred two patients were included between August of 2018 and August of 2019 (age, 59.7 ± 13.6 years; 71 percent women; 51 in each group). No major arrhythmia (ventricular tachycardia, ventricular fibrillation, atrial fibrillation) or arrhythmia-related symptoms were recorded for either group. Minor arrhythmias (including atrial premature beats, ventricular premature beats, and atrial tachycardia) were recorded in 68 patients (66.6 percent), with no statistical difference between the groups. There were three patients with minor arrhythmias during inflation of the tourniquet. Patients in the adrenaline group had 2 percent sinus tachycardia during injection and 4 percent asymptomatic bradyarrhythmias. These findings do not require any further treatment. CONCLUSIONS: The authors' results show that hand operations using WALANT technique in patients with no history of arrhythmia are safe and are not arrhythmogenic; therefore, there is no need for routine perioperative continuous electrocardiographic monitoring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Anestesia Local/métodos , Arritmias Cardíacas , Epinefrina/efeitos adversos , Mãos/cirurgia , Vasoconstritores/efeitos adversos , Adulto , Idoso , Anestesia Local/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Isr Med Assoc J ; 22(4): 219-223, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286023

RESUMO

BACKGROUND: In an effort to alter eye color during World War II, devout Nazi researcher Karin Magnussen had adrenaline eye drops administered to inmates at the concentration camp Auschwitz-Birkenau. A Sinti family, with a high prevalence of heterochromia iridis, was forced to participate in this study. Members of this family, as well as other victims, were later killed and had their eyes enucleated and sent to Magnussen for examination. Magnussen articulated the findings of these events in a manuscript that has never been published. The author is the first ophthalmologist to review this manuscript. The generation who experienced the atrocities of World War II will soon be gone and awareness of what happened during this tragic chapter of world history is fading. OBJECTIVES: To describe these events to raise awareness among future generations. METHODS: A literature review and archival search was conducted. RESULTS: Magnussen's research was based on an animal study published in 1937. For Magnussen's study, adrenaline drops were administered to inmates, including a 12-year-old girl from the Sinti family. As there was a reported case of deaf-mutism within the family, Waardenburg syndrome seems to be the most plausible explanation for this family's heritable heterochromia. CONCLUSIONS: The effort to change eye color was doomed to fail from the beginning because there was a probable diagnosis of Waardenburg syndrome. Extinction of humans for ophthalmological research is an insane act beyond imagination. For the sake of these victims, and for the generations who still feel their pain, it is imperative to tell their stories.


Assuntos
Campos de Concentração/história , Epinefrina/efeitos adversos , Cor de Olho , Experimentação Humana/história , Doenças da Íris/induzido quimicamente , Transtornos da Pigmentação/induzido quimicamente , Epinefrina/administração & dosagem , Feminino , Alemanha , História do Século XX , Experimentação Humana/ética , Humanos , Masculino , Prisioneiros , Violência/história , II Guerra Mundial
10.
A A Pract ; 14(6): e01179, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32224687

RESUMO

Verbal orders in the operating room between the surgeon and circulating nurse are prevalent at many institutions. We present a case in which a communication breakdown involving a verbal order resulted in the patient receiving an excessively high dose of epinephrine via subcuticular infiltration. The overdose was quickly identified by an increase in T-wave amplitude on electrocardiogram (ECG). The hemodynamic changes were treated, and the patient suffered no long-term sequelae. This report emphasizes the need to have strategies in place to prevent medication errors.


Assuntos
Overdose de Drogas/diagnóstico , Epinefrina/efeitos adversos , Erros Médicos/efeitos adversos , Propofol/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Humanos , Lactente , Masculino , Período Perioperatório , Relações Médico-Enfermeiro , Propofol/uso terapêutico , Sevoflurano/administração & dosagem , Sevoflurano/uso terapêutico , Resultado do Tratamento
11.
Cardiovasc Drugs Ther ; 34(2): 189-197, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32146637

RESUMO

PURPOSE: To compare intraosseous access with peripheral venous access on adults out-of-hospital cardiac arrest (OHCA) patients' clinical outcomes. METHODS: A national retrospective multicentre study was conducted based on the French National Cardiac Arrest Registry. Comparison of patients (intraosseous vs. peripheral venous access) was conducted before and after a matching using a propensity score. The propensity score included confounding factors: age, time between the call (T0) to epinephrine (to take account of how quickly vascular access was achieved), the aetiology of OHCA, the shock and the patient initial rhythm at MMT arrival. RESULTS: A total of 1576 patients received intraosseous access, and 27,280 received peripheral intravenous access. Before matching, OHCA patients with intraosseous access were less likely to survive at all stages (return of spontaneous circulation (ROSC), 0-day survival and 30-day survival). No significant difference in neurological outcome was observed. After propensity score matching, no significant differences in 30-day survival rates (OR = 0.763 [0.473;1.231]) and neurological outcome (OR = 1.296 [0.973;1.726]) were observed. However, intraosseous patients still showed lower likelihood of short-term survival (ROSC and 0-day survival) even after propensity score matching was implemented. CONCLUSION: The populations we investigated were similar to those of other studies suggesting that intraosseous access is associated with reduced survival and poorer neurological outcome. Our findings suggest that intraosseous access is a comparably effective alternative to peripheral intravenous access for treating OHCA patients on matched populations.


Assuntos
Agonistas Adrenérgicos/administração & dosagem , Cateterismo Periférico , Epinefrina/administração & dosagem , Parada Cardíaca Extra-Hospitalar/terapia , Ressuscitação/métodos , Administração Intravenosa , Idoso , Cateterismo Periférico/efeitos adversos , Epinefrina/efeitos adversos , Feminino , França , Humanos , Infusões Intraósseas , Masculino , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Recuperação de Função Fisiológica , Ressuscitação/efeitos adversos , Ressuscitação/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Am J Emerg Med ; 38(6): 1297.e1-1297.e3, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31983596

RESUMO

A previously healthy 60-year-old man presented to our emergency department with anaphylactic shock. We initiated fluid resuscitation with Ringer's lactate solution; injected 0.3 mg epinephrine intramuscularly; and administered d-chlorpheniramine maleate 5 mg, famotidine 20 mg, and methylprednisolone 80 mg intravenously. His symptoms resolved within 10 min. Thirty minutes after the epinephrine injection, he complained of sudden chest discomfort. Physical examination provided no evidence of anaphylaxis. The 12-lead electrocardiogram (ECG) showed ST-segment depression on leads II, III, aVF, and V3-6. Transthoracic echocardiography revealed normal ventricular contraction. After administration of 0.3 mg of sublingual nitroglycerin, his chest pain resolved immediately and his ECG normalized. A coronary angiogram showed normal coronary artery perfusion. The next day, his high-sensitivity troponin I was slightly elevated. We suspected that he had myocardial ischemia caused by coronary artery spasm. The symptoms of biphasic reaction of anaphylaxis are inconsistent, and using epinephrine for myocardial ischemia following anaphylaxis may aggravate the condition. Nonetheless, epinephrine is the drug of choice for treating anaphylaxis with critical airway, respiratory, and circulatory compromise. Thus, physicians should not hesitate to use epinephrine for patients who present with life-threatening conditions due to suspected anaphylaxis. Physicians should observe patients closely following epinephrine administration, and if they develop some symptoms, should carefully examine the patients because the treatments of anaphylaxis and myocardial ischemia differs. Physicians should be alert to the risk of myocardial ischemia after treatment of anaphylaxis, especially following epinephrine administration.


Assuntos
Anafilaxia/etiologia , Epinefrina/efeitos adversos , Isquemia Miocárdica/tratamento farmacológico , Anafilaxia/fisiopatologia , Dor no Peito/etiologia , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência/organização & administração , Epinefrina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Vasoconstritores/efeitos adversos , Vasoconstritores/uso terapêutico
16.
BMJ Case Rep ; 13(1)2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31919066

RESUMO

A 65-year-old woman called paramedics for stridor and neck swelling following an insect bite with a possible anaphylactic reaction. On arrival paramedics administered intramuscular epinephrine without any observed improvement in stridor. Paramedics then prepared 5 mg of 1:1000 epinephrine for nebulised administration, which was inadvertently given intravenously. The patient developed tachycardia, anxiety and a severe headache, with biochemical evidence of cardiac necrosis without any haemodynamic compromise. The patient recovered over the next 24 hours and no long-term sequelae were identified on CT coronary angiogram, electrocardiography (ECG) echocardiography or invasive angiography. This case highlights the risk of cardiac ischaemia during epinephrine administration and the importance of protocols to ensure appropriate dosing. This case also raises questions regarding appropriate management of epinephrine overdose and shines a light on the absence of guidelines on the prevention of complications from epinephrine administration.


Assuntos
Anafilaxia/tratamento farmacológico , Overdose de Drogas/complicações , Epinefrina/efeitos adversos , Erros Médicos , Taquicardia Ventricular/induzido quimicamente , Administração Intravenosa , Idoso , Diagnóstico Diferencial , Overdose de Drogas/diagnóstico por imagem , Eletrocardiografia , Serviços Médicos de Emergência , Feminino , Humanos , Injeções Intramusculares , Taquicardia Ventricular/diagnóstico por imagem
17.
Gen Comp Endocrinol ; 287: 113347, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794730

RESUMO

Many marine invertebrate larvae undergo a dramatic morphological and physiological transition from a planktonic larva to a benthic juvenile. The mechanisms of this metamorphosis in bivalves are mainly unknown. The recent identification in bivalves of a thyroid hormone receptor (TR) gene raises the possibility that as occurs in vertebrate metamorphosis, TRs regulate this developmental process. An evolutionary study of TR receptors revealed they are ubiquitous in the molluscs. Knock-down of the TR gene in pediveliger larvae of the hard-shelled mussel, Mytilus coruscus (Mc), using electroporation of siRNA significantly (p < 0.01) reduced TR gene expression. TR gene knock-down decreased pediveliger larval metamorphosis by 54% and was associated with a significant (p < 0.01) reduction in viability compared to control larvae. The TR in the hard-shelled mussel appears to be an essential regulatory factor for the successful epinephrine-induced metamorphosis of the pediveliger larvae to post-larvae. It is hypothesised that the knock-down of TR by siRNA transfection affects the "competence" of pediveliger larvae for the metamorphic transition by reducing their ability to respond to the inducer. The involvement of TR in the epinephrine-induced metamorphosis of a mollusc, the hard-shelled mussel, suggests the role of TR in this process probably emerged early during evolution.


Assuntos
Epinefrina/efeitos adversos , Larva/metabolismo , Metamorfose Biológica/fisiologia , Mytilus , Receptores dos Hormônios Tireóideos/metabolismo , Animais , Transfecção
18.
Dermatol Surg ; 46(5): 581-585, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31567550

RESUMO

BACKGROUND: The incidence of reactions to epinephrine-containing local anesthetics in Mohs micrographic surgery (MMS) has not been established. OBJECTIVE: To estimate the incidence of epinephrine-induced reactions from local anesthetics in patients who undergo MMS for the removal of cutaneous malignancies. METHODS: From 2016 to 2018, 200 MMS patients were recruited from the authors' surgical center. Assessments were obtained throughout the entirety of the Mohs cases during a single visit. RESULTS: This study estimated the incidence of epinephrine reactions in patients who undergo MMS to be 2.0% (95% confidence interval: 0.1%-3.9%). No relationship between epinephrine dose and incidence of adverse effects was found. Patient age was a significant risk factor for the development of an epinephrine reaction. CONCLUSION: Systemic reactions to epinephrine from local anesthetics are an infrequent adverse event in MMS cases. The data suggest that the absolute dose of local anesthetic with epinephrine does not correlate with the risk of developing an epinephrine reaction. Older age seems to have a protective effect.


Assuntos
Anestésicos Locais/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Epinefrina/efeitos adversos , Cirurgia de Mohs , Idoso , Feminino , Humanos , Incidência , Masculino , Oklahoma/epidemiologia
19.
Dermatol Surg ; 46(1): 26-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30829774

RESUMO

BACKGROUND: Recently, the safety of lidocaine plus epinephrine use in outpatient surgery has come under scrutiny despite its long history of use in outpatient dermatologic procedures and surgeries. OBJECTIVE: To assess the frequency of crash cart and other emergency interventions during Mohs micrographic surgery when lidocaine plus epinephrine is used as a local anesthetic and evaluate patient comorbidities associated with these events. MATERIALS AND METHODS: A retrospective chart review was conducted in an outpatient Mohs micrographic surgery clinic. RESULTS: One thousand one hundred twenty-seven Mohs cases were reviewed from the period of March 2015 to June 2016 with 864 meeting the inclusion criteria of patient weight, medical history, and amount of lidocaine administered recorded. No adverse events requiring emergency intervention with a crash cart or transfer to the emergency department occurred despite a patient population with advanced age and a wide range of comorbidities. CONCLUSION: No serious adverse events requiring emergency intervention were associated with lidocaine with epinephrine doses administered below the Food and Drug Administration recommended maximum. The authors did not find evidence from this study or after a literature search to support the requirement for a crash cart and other emergency equipment to be present during procedures.


Assuntos
Anestésicos Locais/efeitos adversos , Epinefrina/efeitos adversos , Lidocaína/efeitos adversos , Cirurgia de Mohs/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Simpatomiméticos/efeitos adversos , Idoso , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Humanos , Injeções Intradérmicas , Injeções Subcutâneas , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Simpatomiméticos/administração & dosagem
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