Hemodynamic effects of tracheal and intravenous adrenaline in infants with congenital heart anomalies.
BACKGROUND
If intravenous access cannot be accomplished during cardiopulmonary resuscitation in children, tracheal administration of 100 micrograms/kg of adrenaline (ten times greater than the intravenous dose) is recommended.


METHODS
In a randomized crossover study we recoreded the hemodynamic effect of a low dose of intravenous adrenaline and a ten times greater tracheal dose. While anesthetized for open heart surgery, fourteen infants received one dose of adrenaline intravenously (0.3 microgram/kg) and the other tracheally (3 micrograms/kg).


RESULTS
During the first 5 minutes after administration mean arterial pressure (MAP) and heart rate (HR) increased after both intravenous and tracheal administration (P < 0.001). The maximum increase in MAP was 28% (17-68%, median and range) after intravenous injection and 20% (6-69%, P < 0.05 when compared to intravenous injection) after tracheal instillation. In four infants, MAP increased less than 10% after tracheal instillation. The maximum increases in MAP and HR occurred 1 min (1-2 min) after intravenous injection and 3 min (2-4 min) after tracheal instillation (P < 0.001).


CONCLUSIONS
Tracheal administration 3 micrograms/kg adrenaline increased mean arterial blood pressure in infants with congenital cardiac anomalies, but the increase occurred later and was less consistent than after 0.3 microgram/kg of adrenaline given intravenously.
Jonmarker
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C
Department of Anesthesia and Intensive Care, Lund University Hospital, Sweden.
Olsson
A K
AK
Jögi
P
P
Forsell
C
C
D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D007322:Instillation, Drug; D014132:Trachea
D004837:Epinephrine