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Ann Intern Med. 2000 May 16;132(10):800-3.

Absorption and hemodynamic effects of airway administration of adrenaline in patients with severe cardiac disease.

Author information

1
Department of Anesthesia, Medizinische Hochschule Hannover, Germany. KRaymondos@aol.com

Abstract

BACKGROUND:

If intravenous access cannot be attained during resuscitation of adult patients, endotracheal application of at least 2 mg of adrenaline is recommended. However, the effects of this intervention have not yet been demonstrated in adults.

OBJECTIVE:

To demonstrate the effects of adrenaline administered through the airways.

DESIGN:

Prospective clinical trial.

SETTING:

Operating theater at university hospital.

PATIENTS:

34 patients receiving implantable cardioverter defibrillators under general anesthesia.

INTERVENTION:

When mean arterial pressure decreased below 80 mm Hg, 100 times the effective central intravenous dose of adrenaline (mean +/- SD, 1.3+/-0.6 mg [range, 0.7 to 3 mg]) was administered over 5 seconds into the endotracheal tube or through a bronchial catheter. Ten forced ventilations followed.

MEASUREMENTS:

Hemodynamic variables were recorded with a polygraph recorder. Adrenaline levels were measured in 13 patients.

RESULTS:

Plasma levels and arterial pressure increased in all patients (P < 0.002). Higher plasma levels (P < 0.039) and greater arterial pressure (P < 0.001) were achieved with this method than with intravenous injection. The effects of adrenaline did not differ between the two airway routes. Sustained ventricular arrhythmia did not occur.

CONCLUSION:

These substantial effects support the standard recommendation to consider the airways as an alternate route for at least 2 mg of adrenaline during resuscitation.

[Indexed for MEDLINE]

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