Possible Interaction: Epinephrine and Sevoflurane

“… sevoflurane … epinephrine 0.5 mcg/ kg intravenously alone resulted in T-wave changes, increased heart rate, and increased blood pressure in 100%, 95%, and 71% of … casting uncertainty on the relative contribution of each.2,3 Was it the bupivacaine or the epinephrine that precipitated the lifesaving ECG changes?”

“In two of our patients, atrioventricular (AV) junctional rhythm (AVJR) transiently occurred following injection of a local anesthetic containing epinephrine under general anesthesia with sevoflurane.”

“ Sevoflurane may increase the likelihood of recognition of an accidental intravascular injection of epinephrine-containing solutions in clinical practice compared with halothane.”

“ Sevoflurane (0.13-0.91 mM) and halothane (0.49-1.25 mM) inhibited secondary platelet aggregation induced by adenosine diphosphate (1-10 micro Meter) and epinephrine (1-10 micro Meter) without altering primary aggregation.”

“It was concluded that either with or without ketamine or thiopentone, the effect of sevoflurane on the sensitisation of the feline myocardium to the arrhythmogenic effects of adrenaline was significantly less than that of halothane and not different from that of isoflurane.”

“The mean dose of adrenaline required to induce arrhythmia during sevoflurane anaesthesia (19.0 micrograms kg-1) was approximately 11 times higher than that required during halothane anaesthesia (1.66 micrograms kg-1) and the same as that required during isoflurane anaesthesia (19.0 micrograms kg-1).”

“These results indicate that the arrythmogenic doses of epinephrine during sevoflurane and isoflurane anesthesia were significantly higher than those during halothane anesthesia.”