Necrosis adrenaline

Peripheral ischemia and necrosis Adrenaline has a potent alpha-1 adrenoceptor stimulating activity. Inappropriate or inadvertent uses of adrenaline causes ischemia of peripheral tissues. There are many case reports on such accidents witii EpiPens and extravasations of TV infusions [15, 16, 17 ]. 

Severn A, Rapson NT, Hunter CA, Liew FY (1992) Regulation of tumor necrosis factor production by adrenaline and beta-adrenergic agonists. J. Immunol. 148 3441-3445. 

Adrenaline 1 100 000, added to lidocaine 2%, has caused full-thickness skin necrosis when used for ambulatory phlebectomy for varicose veins (SEDA-21,136). 

Local tissue reactions, including inflammation and necrosis, can occur, particularly if local anesthetic formulations containing epinephrine (adrenaline) have been administered. Allergic reactions can also occur and are most commonly associated with the esters (e.g. procaine, see Ch. 2). Neurotoxicity is rare but may occur when 200 ml or more of a local anesthetic is administered by infiltration in a short period. It is more likely that a horse will become ataxic, which can lead to selftrauma, after nerve blockade in the limbs, and severe hindlimb ataxia can follow the caudal... 

Some local anaesthetics, lidocaine and bupivacaine, can be used in combination with adrenaline. Adrenaline is a vasoconstrictor and its use increases the speed of onset and prolongs the duration of action of the local anaesthetic. Vasoconstrictors should never be used with local anaesthetics in digits or appendages, because of the risk of vasoconstriction leading to ischaemic necrosis. See page 277 for a list of local anaesthetics and other injectable drugs that can be administered by podiatrists. 

Adrenaline Vasoconstrictor and -dilator binds to a and 3 adrenergic receptors Systemic small- and mediumsized arteries Medial necrosis and hemorrhage smooth muscle cells degeneration/ hypertrophy Greaves (2000)... 

Adrenaline hypertension Anticoagulants, oral skin necrosis Antituberculosis drugs hepatotoxicity Pseudoephedrine toxic epidermal necrolysis SSRIs suicidal behavior Statins acute pancreatitis Ximelagatran liver damage... 

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