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Case Reports
. 2018 Winter;65(4):259-260.
doi: 10.2344/anpr-66-01-02.

Sudden Tachycardia Due to Submucosal Migration of an Epinephrine-Soaked Swab During Nasal Intubation

Tsuyoshi Hoshi  1   2 , Takashi Suzuki  1 , Masayuki Somei  1 , Takehiko Iijima  2 , Yuka Kurihara  1   2
Affiliations
Case Reports

Sudden Tachycardia Due to Submucosal Migration of an Epinephrine-Soaked Swab During Nasal Intubation

Tsuyoshi Hoshi et al. Anesth Prog. 2018 Winter.

Abstract

A 23-year-old healthy man was scheduled for extraction of his mandibular third molars under general anesthesia with nasotracheal intubation. Sudden sinus tachycardia up to 170 beats/min occurred when applying an epinephrine solution-soaked swab into the nasal cavity for preventing epistaxis during intubation. This was presumably evoked by submucosal migration of the swab into a false passage created because of the force applied during a prior failed attempt at nasal passage of the tracheal tube, and rapid epinephrine absorption by the traumatized mucosa. The causes of the unexpected severe tachycardia in our patient are discussed.

Keywords: Epinephrine; Migration; Nasotracheal intubation; Sinus tachycardia; Submucosal dissection.

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