This report describes four patients who had early reversal of local anesthetic and vasoconstrictor effects during nasal surgery. They were all taking tricyclic antidepressants. The basic physiology of adrenergic receptor sites and the pharmacology of tricyclic antidepressants as they relate to catecholamine uptake are presented. An explanation of the adverse effect of the tricyclics is presented based on the concept of “epinephrine-reversal. “
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