J Korean Assoc Oral Maxillofac Surg.  2016 Oct;42(5):295-300. 10.5125/jkaoms.2016.42.5.295.

Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 2Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. ribosome@hanmail.net

Abstract

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

Keyword

Epinephrine; Orthognathic surgery; Local anesthesia; Lactic acidosis; Topical administration

MeSH Terms

Acidosis, Lactic*
Administration, Topical
Anesthesia, General
Anesthesia, Local
Epinephrine
Glucose
Glycolysis
Hemodynamics
Hemostasis
Humans
Lactic Acid
Orthognathic Surgery*
Plasma
Pyruvic Acid
Vital Signs
Epinephrine
Glucose
Lactic Acid
Pyruvic Acid
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