Portal de Periódicos da CAPES

Truth, and Epinephrine, at Our Fingertips: Unveiling the Pseudoaxioms

2007; Elsevier BV; Volume: 50; Issue: 4 Linguagem: Inglês

10.1016/j.annemergmed.2007.06.016

1097-6760

David H. Newman,

Innovations in Medical Education

In an effort to demonstrate epinephrine’s safety when added to anesthetic agents for regional block anesthesia, in a 1991 report 2 British hand surgeons injected their own toes with epinephrine. Much to the surprise (and perhaps head-shaking giggles) of their colleagues, both physicians and all of their toes survived, intact. Despite the humor, the drama of the act is telling. The anecdote conjures a famous experiment performed 7 years earlier by a similarly frustrated gentleman who drank a flask of Helicobacter pylori to test his hypothesis that peptic ulcer disease is often bacterial in origin. Within a few days, Dr. Barry Marshall had fallen ill, and within a few decades he had won the Nobel Prize in Medicine. The British surgeons Latimer and Kay, on the other hand, have remained no more recognized than the falsehood they challenged. In this issue of Annals, Waterbrook et al present a laudable review of the evidence pertaining to the safety of epinephrine, an effective hemostatic agent that prolongs and improves digital anesthesia. The review is important and indeed potentially groundbreaking in that it opens a largely undiscussed Pandora’s Box: the medical pseudoaxioms. Although axioms are universally accepted principles or rules, pseudoaxioms, like pseudoscience, are false principles or rules often handed down from generation to generation of medical providers and accepted without serious challenge or investigation. In 1956, a popular textbook of hand surgery published the ominous warning “epinephrine should never be injected into the finger because from this gangrene has often resulted.” Among the cases cited to support this and later assertions were reports of procedures during which, as often as not, no epinephrine was used. In those in which epinephrine was present the “gangrene” was frequently a circumferential burn from a misguided but apparently common home antisepsis remedy in which the still-anesthetized finger was soaked in hot, often boiling, water or boric acid. Add to these reports epinephrine’s in vivo half-life (short), vasoconstrictive impact (mild), and native propensity for inducing infection (none), and the implausibility of a digit-threatening event caused by epinephrine becomes evident. The danger of injectable