Concentrated Epinephrine Use in the Operating Room

A 16-year-old male with history of nasal obstruction secondary to acquired traumatic deformity was scheduled for outpatient external approach septorhinoplasty and inferior turbinate reduction. Preoperative exam was unremarkable, and the case was cleared to proceed by both the surgical and anesthesia teams. Following routine induction of general anesthesia and endotracheal intubation, the surgeon was handed an unlabeled syringe for local anesthetic infiltration of the external nose, turbinates, and septum. This syringe contained only 3 mL of clear fluid which the surgeon noted at the time, commenting that the team would eventually require more local anesthetic. After preoperative timeout was performed, the anesthesia team was notified that “lidocaine with epinephrine” was being injected locally. Following a brief delay, the scrub tech exclaimed that they had accidentally given the surgeon the incorrect syringe – instead of 1% lidocaine with 1:100,000 epinephrine, the surgeon had been given a syringe containing 1:1000 epinephrine. The injection was immediately discontinued after an estimated 0.8 mL had been injected into the right inferior turbinate. The anesthesia team was quickly notified of the situation and the head of the turbinate was incised with a 15-blade in an attempt to express any residual epinephrine before it was absorbed systemically.