Topical epinephrine is useful to reduce bleeding during skin grafting. However, even though a clear operative field is obtained, systemic absorption of topical epinephrine can occur and this may cause severe hypertension, arrhythmias, ventricular tachycardia, myocardial ischemia, pulmonary edema, or cardiac arrest. We managed a case of cardiac arrhythmia during general anesthesia, which was induced by gauze soaked in topical epinephrine used for skin grafting of burn wounds. A 26-year-old woman developed premature ventricular complexes and ventricular tachycardia during surgery when epinephrine-soaked gauze was applied to the skin donor and burn wound sites to control oozing. The patient was resuscitated immediately and within 10 minutes the vital signs had normalized. It is recommended that caution is exercised when epinephrine-soaked gauze is applied to a large area of skin.
Absorption ; Adult ; Anesthesia, General ; Arrhythmias, Cardiac ; Burns ; Epinephrine ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Hypertension ; Myocardial Ischemia ; Pulmonary Edema ; Skin ; Skin Transplantation ; Tachycardia, Ventricular ; Tissue Donors ; Ventricular Premature Complexes ; Vital Signs