Authors :
Dr. Gurpreet Singh Battu; Dr. Anish Pal; Dr. Manjot Kaur; Dr. Harinder Pal Singh
Volume/Issue :
Volume 10 - 2025, Issue 1 - January
Google Scholar :
https://tinyurl.com/4scysy2k
Scribd :
https://tinyurl.com/nhdmvf2h
DOI :
https://doi.org/10.5281/zenodo.14792229
Abstract :
Blood loss during surgery, particularly in vaginal hysterectomy, is a significant concern for both surgeons and
anesthesiologists. Various techniques, including the use of local infiltration with adrenaline, are commonly employed to
reduce blood loss and improve hemostasis. While the benefits of adrenaline infiltration are well-established, its potential to
cause serious cardiovascular complications, such as tachyarrhythmias and acute hypertension, cannot be overlooked. This
case report describes an accidental intravascular injection of adrenaline during vaginal hysterectomy in a 47-year-old
patient, leading to a severe cardiovascular crisis. The patient experienced a sudden onset of tachycardia, hypertension, chest
pain, headache, and pulmonary edema following submucosal adrenaline infiltration. The situation was promptly managed
with a combination of antiarrhythmics (lignocaine, esmolol, and amiodarone), diuretics (furosemide), and 100% oxygen,
resulting in stabilization of the patient’s condition. After a period of intensive monitoring in the ICU, the patient made a full
recovery, with normal sinus rhythm and no long-term sequelae. This case highlights the importance of recognizing the
potential risks associated with local infiltration of adrenaline and the necessity of careful monitoring during its
administration. It is essential to have appropriate medications and interventions readily available in such scenarios, and to
ensure timely detection and management of complications to ensure patient safety.
References :
- Sharma S, Rare adverse effect of adrenaline in vaginal hysterectomy. Indian J Clin Anaesth 2021;8(3):490-491.
- Gupta, N., & Gupta, V. (2014). Life-threatening complication following infiltration with adrenaline. Indian Journal of Anaesthesia, 58(2), 225-227.
- Greene, B. H., Lalonde, D. H., & Seal, S. K. (2021). Incidence of the “adrenaline rush” and vasovagal response with local anesthetic injection. Plastic and Reconstructive Surgery–Global Open, 9(6), e3659.
- Zakka, K., Gadi, S., Koshlelashvili, N., & Maleque, N. M. (2020). Acute myocardial injury after administration of intravenous epinephrine for allergic reaction. SAGE Open Medical Case Reports, 8, 2050313X20933104.
Blood loss during surgery, particularly in vaginal hysterectomy, is a significant concern for both surgeons and
anesthesiologists. Various techniques, including the use of local infiltration with adrenaline, are commonly employed to
reduce blood loss and improve hemostasis. While the benefits of adrenaline infiltration are well-established, its potential to
cause serious cardiovascular complications, such as tachyarrhythmias and acute hypertension, cannot be overlooked. This
case report describes an accidental intravascular injection of adrenaline during vaginal hysterectomy in a 47-year-old
patient, leading to a severe cardiovascular crisis. The patient experienced a sudden onset of tachycardia, hypertension, chest
pain, headache, and pulmonary edema following submucosal adrenaline infiltration. The situation was promptly managed
with a combination of antiarrhythmics (lignocaine, esmolol, and amiodarone), diuretics (furosemide), and 100% oxygen,
resulting in stabilization of the patient’s condition. After a period of intensive monitoring in the ICU, the patient made a full
recovery, with normal sinus rhythm and no long-term sequelae. This case highlights the importance of recognizing the
potential risks associated with local infiltration of adrenaline and the necessity of careful monitoring during its
administration. It is essential to have appropriate medications and interventions readily available in such scenarios, and to
ensure timely detection and management of complications to ensure patient safety.
