We report about detailed hemodynamic changes and one major cardiac complication
occurring after submucosal injection of epinephrine (1 : 10 000) for management
of upper gastrointestinal bleeding in a series of four consecutive patients. Cardiac
contractility and afterload, determined by the cardiac index and the systemic
vascular resistence index (SVRI), were assessed by transpulmonary thermodilution
using the Pulse Contour Cardiac Output monitoring system (PiCCO; Pulsion Medical
Systems, Munich, Germany), and the mean arterial pressure and heart rate were
recorded. We observed a distinct rise in both mean arterial pressure and heart
rate, and this effect was pronounced in the three patients with esophageal lesions.
The increase in the mean arterial pressure was caused by an elevation of the
cardiac index in two patients, a rise in both cardiac index and SVRI in one patient,
and a rise in the SVRI only in the fourth patient. One patient, who had received
30 ml epinephrine for treatment of a bleeding Mallory-Weiss tear, developed an
acute myocardial infarction during the postprocedural follow-up period. In conclusion,
submucosal injection of epinephrine may cause significant hemodynamic changes
that can potentially lead to adverse cardiac events. Close cardiac monitoring
during and after submucosal application of epinephrine therefore seems a prudent
precaution. In the treatment of esophageal lesions, the total amount of epinephrine
injected should be carefully titrated, so that the lowest possible volume that
achieves adequate hemostasis is used.
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S. von Delius, M. D.
Technical University of Munich
Klinikum Rechts der Isar · 2nd Medical Department · Ismaninger Straße 22 · 81675
München · Germany
Fax: +49-89-41404968
Email: stefan_ruckert@yahoo.de
