Systemic epinephrine toxicity following topical epinephrine gauze use during burn debridement

Abstract: A 54-year-old male with extensive burns caused by a high-voltage alternating current electrical injury underwent three surgical debridement procedures. During the first operation, he developed intraoperative hypertension and tachycardia, followed postoperatively by hypotension, lactic acidosis, hyperglycemia, and hypokalemia, which improved with fluid resuscitation and vasopressor support. Similar hemodynamic and metabolic disturbances recurred during the second debridement. A detailed review of the anesthetic records revealed that epinephrine-soaked gauze had been applied intraoperatively for hemostasis, with vital sign changes occurring shortly thereafter. These findings suggested systemic epinephrine toxicity, followed by hypotension related to antihypertensive therapy. After discussion with the plastic surgery team, topical epinephrine was avoided during the third procedure and replaced with thrombin-soaked gauze, with no recurrence of complications. This case highlights that topical epinephrine used for hemostasis in extensive burn wounds can cause clinically significant systemic toxicity and underscores the importance of interdepartmental communication in preventing perioperative adverse events.