Editorial Type:
Article Category: Case Report
 | 
Online Publication Date: Jan 01, 2018

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

DDS,
MD, PhD,
MD, PhD,
DDS, PhD, and
DDS
Page Range: 259 – 260
DOI: 10.2344/anpr-66-01-02
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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.

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Copyright: © 2018 by the American Dental Society of Anesthesiology

Contributor Notes

Address correspondence to Takashi Suzuki, MD, PhD, Department of Anesthesiology, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo 135-8577, Japan; tksuzuki@med.showa-u.ac.jp.
Received: Nov 26, 2017
Accepted: Apr 14, 2018