What is the MOST likely consequence of inadvertent intravascular injection of a local anesthetic containing epinephrine?

Correct answer: D. Palpitations with a transient rise in heart rate and blood pressure

• A. ❌ True allergy to amide anesthetics is very rare, and the cardiovascular response described is pharmacological, not immunologic.
• B. ❌ Paresthesia results from direct needle trauma or neurotoxicity (associated with 4% articaine and prilocaine), not from intravascular delivery.
• C. ❌ The opposite — the solution is carried away by the bloodstream instead of diffusing to the nerve, so anesthesia FAILS.
• D. ✅ CORRECT — Epinephrine delivered directly into the circulation produces immediate beta-1 stimulation: PALPITATIONS, tachycardia, a rise in blood pressure, tremor, anxiety and headache. The episode is alarming but usually self-limiting within minutes because epinephrine is metabolized rapidly.

Note: Prevention: ASPIRATE in two planes before every deposit, and inject slowly — no faster than 1 mL per minute (a full cartridge over at least 60 seconds).