To the Editor.—My attention was drawn to the commentary1 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 articles2 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,
WARD CF. Otolaryngologists Using Local Anesthetics Containing Epinephrine. Arch Otolaryngol. 1985;111(4):281. doi:10.1001/archotol.1985.00800060104023
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