Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

  • Son, Hee-Won (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Se-Hun (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Cho, Hyun-Oh (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Shin, Yong-Joon (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Son, Jang-Ho (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Received : 2016.04.04
  • Accepted : 2016.08.17
  • Published : 2016.10.31
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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 ${\beta}2$-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.

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References

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