Junctional rhythm with severe hypotension followinginfiltration of lidocaine containing epinephrineduring dental surgery

We experienced an unusual case of accelerated junctional rhythm with severe hypotension after infiltration oflidocaine containing epinephrine during dental surgery under general anesthesia. The patient’s electrocardiogramexhibited retrograde P-waves following the QRS complex, which could be misinterpreted as ST-segment depression.As a temporary measure, administration of ephedrine restored the patient’s blood pressure to normal levels.The importance of this case lies in its demonstration of an unexpected and serious side effect of commonlyused epinephrine infiltration. This case also highlights the need for accurate interpretation of the electrocardiogramand comprehensive understanding of best practices for patient management.