Epinephrine to raise hr during surgery?

Question

For surgeons who perform awake lipo - with Ativan and opioid like Percocet... and the antinausea pill... If a patients pulse drops to 56 during surgery is it normal to administer epinephrine to raise it back up? Is it normal to not tell the patient this happened until 3 months later? Is this a normal complication and is it serious? Thank you in advance.

David Hansen, MD · Answer

A pulse rate of 56 is normal during any surgery whether local or general anesthesia is used. The more relaxed the patient is then the slower the heart rate. Many patients have a normal heart rate in the 50’s whether surgery or not. Athletes routinely run in the 50’s.  Giving epi is optional and of no significance and not serious at all.

Semih Yildiz, MD, FEPOBRAS · Answer

A pulse of 56 during awake liposuction is not automatically dangerous by itself. Whether it matters depends on the whole picture: blood pressure, oxygen level, symptoms, rhythm on the monitor, medications given, amount of tumescent fluid, and whether the heart rate recovered quickly.

Epinephrine is commonly used in tumescent liposuction fluid to reduce bleeding, and it can also raise the heart rate. If the issue was true symptomatic bradycardia, the treatment choice depends on the monitor findings and the clinician’s judgment at that moment. Other medications, anxiety, a vasovagal response, nausea, pain, or sedation can all affect heart rate during an awake procedure.

In general, any meaningful intraoperative event should be documented and explained to the patient, especially if medication was given specifically to treat a vital-sign change. A brief heart rate of 56 with stable blood pressure and oxygen may be minor, but it is reasonable for you to ask exactly what happened rather than guessing.

I would request a copy of your operative record, nursing record, and medication record, then review it with your surgeon or an anesthesiologist. If you have had chest pain, fainting, palpitations, shortness of breath, or ongoing dizziness, you should also see your primary doctor or a cardiologist for evaluation.

Connie Hiers, MD, FACS · Answer

Heart rate can decrease in surgery, especially with medication. If your blood pressure is stable and other monitors, you may be watched or given medication to raise the rate. This is not serious when you are being monitored and watched, and this is usually not discussed with patients since is due to medication at that moment and may not happen again. If you have an unusual response to medication, the surgeon usually lets the patient know so they can tell the next surgeon if he/she needs surgery later.

Camille Cash, MD · Answer

The normal heart rate range is 60-100 beats per minute, however some people especially runners may have a resting heart rate in the 50's or even the 40's.  A heart rate of 56 bpm would not be concerning as the medications you mentioned relax the patient and may lower the heart rate somewhat.

Epinephrine to raise hr during surgery?

Answers (4)

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