A case of hypotension after intranasal adrenaline infiltration causing a clinical dilemma during the intraoperative period

Abstract

Solutions containing adrenaline are widely used for presurgical infiltration. Haemodynamic changes associated with its use are well documented in the literature. Prolonged intraoperative hypotension after subcutaneous infiltration of diluted adrenaline is an uncommon scenario. We believe that our case of the prolonged episode of hypotension was secondary to infiltration of nasal septum with a high concentration of adrenaline. As β2 receptor activation leads to skeletal muscle vasodilation, a decrease in preload may have lead to profound hypotension. Postoperatively, the patient was examined and any autonomic or endocrinological pathology was ruled out.

Keywords

• Adrenaline
• anaphylaxis
• Bezold Jarisch reflex
• hypotension
• β2 receptor