When used in recommended dosages and administered by the intended route of the formulation, epinephrine is the clinician’s best friend. In fixed-dose auto-injectors it is the drug of choice for the treatment of anaphylactic reactions in oral healthcare settings, but immediately following the administration of epinephrine, the patient must be referred for additional medical care. Call 911 and while waiting for the EMS, prepare to initiate CPR and automated cardiac defibrillation.
The use of epinephrine with LAs is standard dental practice. The question to ask is not whether epinephrine should be used – the question to ask is how much epinephrine can be used safely. To minimize serious medication errors, think of dosage strengths of epinephrine in mg/mL of LA rather than ratio expressions (e.g., 1:100,000). In general, the MRD of epinephrine with LAs for healthy adults is 0.2 mg per visit; in high-risk populations, 0.02 to 0.05 mg is recommended.
Toxicity associated with epinephrine overdosage is characterized by increased HR and force of myocardial contraction, which may lead to angina pectoris, MI, fatal arrhythmias, heart failure, and cardiac arrest. Increased cardiac stimulation and peripheral vascular resistance may also lead to rapid rise in BP, which may lead to pulmonary edema and respiratory failure. Call 911 and while waiting for the EMS, prepare to initiate CPR and automated cardiac defibrillation.