Dilute epinephrine is used to reduce bleeding during surgery, either as a topical or injected agent. Toxicity can occur if too much epinephrine is absorbed.
Usually a dilute concentration is used for injection, 0.005% or less.
The concentration used for topical application is often 1 in 100,000.
Risk factors for toxicity with injected epinephrine:
(1) use of too high a concentration
(2) injection directly into an artery
(3) repeated and excessive administration
Risk factors for toxicity with topical epinephrine:
(1) application over a large surface area
(2) application over highly vascular tissue, an open wound or into medullary bone
Topical absorption may be slow, so the appearance of toxic effects may be delayed.
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