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Pharmacology · single question

What is the recommended MAXIMUM dose of epinephrine (as vasoconstrictor in local anesthetic) for a patient with significant cardiovascular disease?

  1. 0.04 mg (40 μg) — the cardiac dose limit
  2. No epinephrine should ever be used
  3. 0.5 mg (500 μg)
  4. 0.2 mg (200 μg) — same as a healthy patient
Show answer and explanation

Correct answer: A. 0.04 mg (40 μg) — the cardiac dose limit

  • A. CORRECT — For patients with significant cardiovascular disease (ASA III, stable angina, controlled HTN, post-MI >6 months), the recommended MAXIMUM epinephrine dose is 0.04 mg (40 μg). This corresponds to approximately 2 cartridges of 1.8 mL lidocaine with 1:100,000 epinephrine (each cartridge contains ~18 μg epi).
  • B. Epinephrine is not absolutely contraindicated in cardiac patients — a moderate amount actually improves anesthesia quality and reduces catecholamine surge from pain. The cardiac dose limit (0.04 mg) is the standard.
  • C. 0.5 mg is far above any recommended dose and would produce hypertensive crisis or arrhythmia.
  • D. 0.2 mg (200 μg) is the maximum dose for a healthy adult, not for a cardiac-compromised patient.

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