Otolaryngologists Using Local Anesthetics Containing Epinephrine

Abstract

To the Editor .—My attention was drawn to the commentary 1 concerning epinephrine use in patients receiving β-blockers. I, in turn, feel compelled to also express a commentary. The final paragraph stated, with the introductory phrase For example, what I interpreted to be a specific recommendation to discontinue propranolol therapy three days prior to the use of epinephrine-containing anesthetics. To be fair, the sentence immediately prior to this one had recommended this action only if possible. Even so, I think it is critical to point out that a number of articles 2 have examined the subject of propranolol withdrawal and have noted a very real incidence of rebound myocardial ischemia subsequent to removal of β-blockers. Admittedly, an increasing number of patients are receiving propranolol for blood pressure control instead of for reduction of myocardial oxygen demand, but despite this, I would strongly recommend extreme caution in withdrawal of β-blockers,