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C. F. WARD, MD
San Diego

Arch Otolaryngol. 1985;111(4):281.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—My attention was drawn to the commentary¹ concerning epinephrine use in patients receiving β-blockers. I, in turn, feel compelled to also express a commentary. The final paragraph stated, with the introductory phrase "For example," what I interpreted to be a specific recommendation to discontinue propranolol therapy three days prior to the use of epinephrine-containing anesthetics. To be fair, the sentence immediately prior to this one had recommended this action only "if possible." Even so, I think it is critical to point out that a number of articles² have examined the subject of propranolol withdrawal and have noted a very real incidence of "rebound" myocardial ischemia subsequent to removal of β-blockers. Admittedly, an increasing number of patients are receiving propranolol for blood pressure control instead of for reduction of myocardial oxygen demand, but despite this, I would strongly recommend extreme caution in withdrawal of β-blockers, . . . [Full Text PDF of this Article]

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