Acute massive pulmonary edema and myocardial infarction after intranasal infiltration of adrenaline during septorhinoplasty

We present a case report of 13 years old male child undergoing septorhinoplasty under general anesthesia, who developed acute massive pulmonary edema following intranasal infiltration of 330 micrograms of inj. adrenaline by the ENT surgeon. Echocardiography showed local wall hypokinesia with ejection fraction [EF] reduced to 20% and raised troponin-T levels [10 times of normal] suggesting it was adrenaline induced acute myocardial infarction and subsequent cardiogenic pulmonary edema. The surgery was postponed and the patient was successfully treated in ICU with positive pressure ventilation, frusemide and ionotropic support. His EF returned to 50% at 5hr and to 70% at 10 hr; and he was extubated after 14 hours and discharged after 5 days