Epinephrine: Benign side effects compared to dangerous ones

FreespiritedFem said:

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

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

On 2004-04-02 00:48:00 -0500, [email hidden] (FreespiritedFem) said:

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.

Quoted message said:

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

On 01 Apr 2004 17:46:14 GMT, [email hidden] (FreespiritedFem)

Quoted message said:

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'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.

Quoted message said:

On 01 Apr 2004 17:46:14 GMT, [email hidden]
(FreespiritedFem) wrote: 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*.

anon said:

Quoted message said:

On 01 Apr 2004 17:46:14 GMT, [email hidden]
(FreespiritedFem) wrote: 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.

Quoted message said:

Is Primatene mist still on the market? I thought it had
been discontinued.

It *should* be. Nope, it's still out there. See:
primatene.comindex.aspOpen ↗

anon said:

Quoted message said:

Is Primatene mist still on the market? I thought it had
been discontinued.

It *should* be. Nope, it's still out there. See:
primatene.comindex.aspOpen ↗

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.