Sinus tachycardia adrenaline

A 46-year-old man received an axillary nerve block using 40 ml of 0.5% ropivacaine with 1 200 000 adrenaline and 45 seconds later developed a sinus tachycardia and started screaming, appearing terrified. He struck out violently with all limbs and sat upright, attempting... 

A 76-year-old woman received an interscalene block using 20 ml of 0.75% ropivacaine with 1 400 000 adrenaline. At the end of the injection, she sat up and appeared extremely terrified she screamed twice, fell back on the stretcher, and began moving the unblocked arm and both legs in clonic movements, remaining unresponsive to verbal command. She had a sinus tachycardia and hypertension (205/70 mmHg). The seizure abated with thiopental. 

Adrenaline is contraindicated in cases of diabetes, hyperthyroidism, serious heart arrhythmias and coronary insufficiency or in combination with beta-blockers or monoamine oxidase (MAO) inhibitors. Lidocaine with adrenaline has a very rapid onset of action. Its duration of action is longer than that of lidocaine without adrenaline. However, inadvertent injection of a lidocaine-adrenaline solution into the vessels located near the nerve trunks increases the heart rate (immediate sinus tachycardia at over 130 beats per minute, spontaneously reversible in around 15 minutes) and increases ventricular excitability (risk of fibrillation). It can trigger angina attacks that may lead to a heart attack. It is therefore preferable not to use adrenaline before a full-face phenol peel. 

In addition to drugs in these classes, others may be used for certain arrhythmias. Digoxin may be used for treatment of atrial fibrillation, adrenaline for asystolic cardiac arrest, atropine for sinus bradycardia, methacholine (rarely) for supraventricular tachycardia, magnesium salts for ventricular arrhythmias, and calcium salts for ventricular arrhythmia due to hyperkalaemia. 

Two patients with supraventricular tachycardia (180 bpm) were treated, firstly with intravenous practolol (20 and 10 mg respectively) and shortly afterwards with disopyramide (150 and 80 mg respectively). The first patient rapidly developed sinus bradycardia of 25 bpm, lost consciousness and became profoundly hypotensive. He did not respond to 600 micrograms of atropine, but later his heart rate increased to 60 bpm while a temporary pacemaker was being inserted. He was successfully treated with disopyramide 150 mg alone for a later episode of tachycardia. The second patient also developed severe bradycardia and asystole, despite the use of atropine. He was resuscitated with adrenaline (epinephrine) but later died. ... 

Drug overdose Life-threatening flecainide intoxication in a 2-year-old toddler occurred when syringes used for oral administration were accidentally reversed, producing a fivefold flecainide overdose 3 hours after drug administration he developed a bradycardia of 50/minute and had a cardiopulmonary arrest, requiring resuscitation and adrenaline, after which the bradycardia recurred, followed by a wide-complex tachycardia that converted rapidly to a narrow-complex tachycardia after bolus intravenous adrninistration of sodium bicarbonate [60 ]. He then remained hemo-dynamicaUy stable and in sinus rhjflhm. The serum flecainide concentration was 0.7 mg/1. 

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