Accidental Intravascular Adrenaline Rush Following Local Infiltration in Vaginal Hysterectomy in a Wide Awake Patient (A Rare Case Report)

Blood loss during surgery, particularly in vaginal hysterectomy, is a significant concern for both surgeons and anesthesiologists. Various techniques, including the use of local infiltration with adrenaline, are commonly employed to reduce blood loss and improve hemostasis. While the benefits of adrenaline infiltration are well-established, its potential to cause serious cardiovascular complications, such as tachyarrhythmias and acute hypertension, cannot be overlooked. This case report describes an accidental intravascular injection of adrenaline during vaginal hysterectomy in a 47-year-old patient, leading to a severe cardiovascular crisis. The patient experienced a sudden onset of tachycardia, hypertension, chest pain, headache, and pulmonary edema following submucosal adrenaline infiltration. The situation was promptly managed with a combination of antiarrhythmics (lignocaine, esmolol, and amiodarone), diuretics (furosemide), and 100% oxygen, resulting in stabilization of the patient’s condition. After a period of intensive monitoring in the ICU, the patient made a full recovery, with normal sinus rhythm and no long-term sequelae. This case highlights the importance of recognizing the potential risks associated with local infiltration of adrenaline and the necessity of careful monitoring during its administration. It is essential to have appropriate medications and interventions readily available in such scenarios, and to ensure timely detection and management of complications to ensure patient safety.