Sensitive to lidocaine with epinephrine. Would this be a problem during rhinoplasty under general anesthesia?

Question

I am planning on doing rhinoplasty. Healthy, athletic, exercise daily, cleared by the cardiologist . However, whenever I get lidocaine administered with epinephrine at the dental office - I get ntachycardia for 5-10 minutes. I also get shaking in the area where epinephrine is injected. Lidocaine with no epinephrine has no bad effect on me. It's a sensitivity I've come to expect. Would this tachycardia be problematic under general anesthesia? Also, would my nose shake under general?

Oakley Smith, MD, FRCSC · Answer

The reaction you described with lidocaine with epinephrine is an expected effect as epinephrine has a known effect to increase heart rate. If you are under general anesthesia, then this will not be a problem as you will be monitored throughout the case. We would not expect any shaking of the nose to occur.

Stephen Kleid, MBBS, FRACS · Answer

The Epinephrine works as a vasoconstrictor, and is used to reduce bleeding during nasal surgery.The blood loss in Rhinoplasty is not dangerous, it just makes it more difficult for the surgeon to do delicate surgery, and slows the operation whilst bleeding is stopped.
Other vasoconstrictors can be used, that are less likely to cause problems, such as Naropin (Ropivocaine)
Also - your anesthetist can give medications to counteract the tachycardia you get from epinephrine.

Ronald J. Edelson, MD · Answer

Your question is a common one. With dentistry the epinephrine sets absorbed more quickly into your system than with a rhinoplasty. I’ve done many operations using lidocaine with epi on patients who have had your type of experience with dental work. I have never seen a problem in that situation but certainly discuss it with your surgeon and anesthesiologist

Mark Baldwin, MBBS · Answer

We're all very sensitive to epinephrine (otherwise called adrenaline). Some people will consciously notice the effects of minute amounts that are absorbed into the bloodstream when it is injected into soft tissues (ie without any accidental intravascular injection). It won't make your nose shake and your pulse rate and blood pressure can be controlled by your anaesthetist. Best wishes.

Akshay Sanan, MD, FACS · Answer

Dear Compassionate3320,Thank you for submitting your question. Tachycardia after an epinephrine injection is expected as this is a normal reaction to the medication. When you are under general anesthesia for a rhinoplasty, your vitals are being closely monitored by the anesthesiologist and your heart rate can be regulated with medication. I do not anticipate tachycardia being problematic for you under general anesthesia, and I would also recommend you speak to the anesthesiologist about this prior to your surgery. Lastly, your nose will not shake while under general anesthesia.I hope this answers your question!
All the best,Dr. Sanan, MDAkshay Sanan, MD Facial Plastic SurgeryLos Angeles, CA

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Sensitive to lidocaine with epinephrine. Would this be a problem during rhinoplasty under general anesthesia?

Answers (5)

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