A patient experiencing a decrease in heart rate during administration of intravenous ephedrine: A case report

Ephedrine is a sympathomimetic agent with α1, β1, and β2 adrenergic-receptor effects inducing hypertension and tachycardia. It has direct post-synaptic adrenergic receptor agonism and indirect action by competitively inhibiting nor-adrenaline reuptake by synaptic vesicles at sympathetic nerve terminals, thus increasing its local concentration. We describe a case of a 35-year-old male, American Society of Anesthesiologists (ASA) physical status class II, undergoing right mastoidectomy for recurrent right post-auricular abscess, who developed repeated reduction in heart rate, each time after receiving an intravenous ephedrine bolus (6–9 mg/bolus). One of the possible reasons could be the simultaneous push of remifentanil during each bolus.