Anesthetics for surgical procedures and allergic reactions

If possible, Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) patients should try to avoid the use of any anesthetic that contains epinephrine due to its negative side effects.


Epinephrine (also known as adrenaline), norepinephrine or one of its analogs called levonordefrine, is commonly added to local anesthetics given for dental procedures and other minor surgical procedures requiring a local anesthestic. Some people with Th1 inflammatory diseases react abnormally to epinephrine in a local anesthetic. One reason why this may be is that E. coli produces epinephrine for communication with other members of the species in a process known as quorum sensing.1) This may be because pathogens are able to more effectively communicate and spread during times when the body is weakened.

There are many anecdotal accounts of patients with Th1 inflammatory diseases experiencing increased local inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. (redness), local tissue damage, decreased anesthetic effect (numbness) and systemic reactions such as palpitations, rapid heart rate, anxiety, tremor and headache following injection with a local anesthetic containing epinephrine.

Epinephrine is not an essential component of a local anesthetic. Its only function is to reduce the reabsorption of the anesthetic by constricting blood vessels to prolong the numbing action of the anesthetic.

Local anesthetics without epinephrine

Lidocaine, xylocaine, prilocaine and mepivicaine (Isocaine) are common local anesthetics that are available without epinephrine. Although these ‘locals’ are short acting without the vasoconstrictor added, they still produce adequate anesthesia for short procedures and can be readministered as needed.

Marshall Protocol (MP) patients who are to undergo a procedure requiring a local anesthetic can avoid potential uncomfortable reactions by insisting that the physician performing the procedure use a local anesthetic that contains no epinephrine. This request should be made in advance of the procedure date to help ensure that the correct medication is available at the time of the procedure.

Use of epi-pen for allergic reaction

Epinephrine in an injector (epi-pen) is sometimes used for the emergency treatment of severe allergic reactions. For MP patients, the decision to use an epi-pen after exposure to a known allergen and in the presence of worrisome systemic symptoms should be an individual one.

In an urgent or emergency situation the risk/benefit weighs heavily in favor of the use of epinephrine.

The use of epinephrine is primarily a problem when dealing with surgery, including dental surgery.

The epi pen is OK if doc tells you to use it, and if you have not reacted badly to it in the past. Some Th1 patients find that epinephrine does not work properly for them. Rather than constricting the flow of peripheral blood, it causes vasodilation and increases perfusion in the periphery rather than decreasing it.

Trevor Marshall, PhD

===== Notes and comments =====

===== References =====

Sperandio V, Torres AG, Jarvis B, Nataro JP, Kaper JB. Bacteria-host communication: the language of hormones. Proc Natl Acad Sci U S A. 2003 Jul 22;100(15):8951-6. doi: 10.1073/pnas.1537100100. Epub 2003 Jul 7.
[PMID: 12847292] [PMCID: 166419] [DOI: 10.1073/pnas.1537100100]
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