We report a case of wide QRS tachycardia after the local administration of adrenaline to reduce bleeding in a patient under general anesthesia. A 77-year-old woman with suspected angina but no symptoms, such as chest pain, was scheduled to undergo a partial maxillectomy for a malignant tumor in the gingiva. The preoperative laboratory findings were normal, and an electrocardiogram (ECG) revealed a sinus rhythm. Anesthesia was administered with propofol and rocuronium and was maintained with air/oxygen sevoflurane (1.2%) and remifentanil. Before the start of surgery, the patient’s nasal mucosa was soaked with 1 : 100,000 adrenaline using a tampon to prevent bleeding, and 1% lidocaine containing 1 : 100,000 adrenaline was injected into the gingival mucosa for the surgery. About 10 min after soaking the mucosa with adrenaline and 5 min after the local injection, the patient’s blood pressure (BP) and heart rate (HR) suddenly increased and wide QRS tachycardia was observed on an ECG. The wide QRS tachycardia lasted intermittently for 22s, and the patient’s hemodynamic state then stabilized and spontaneously recovered to a sinus rhythm with a gradual decrease in BP and HR.
In this case, the light anesthesia could have caused wide QRS tachycardia ; however, the surgery was at the stage of the gingival incision, so the depth of anesthesia was unlikely to have been the only problem. Sevoflurane has a lower risk of adrenaline-induced arrhythmia than other inhalation anesthetics, but some studies have shown the occurrence of arrhythmia caused by adrenaline administration in the head and neck region in patients under general anesthesia with sevoflurane. Therefore, the careful use of adrenaline in small amounts is required, and adrenaline-induced arrhythmias must be appropriately managed.
