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


METHODS
Prospective clinical trial.


METHODS
Operating theater at university hospital.


METHODS
34 patients receiving implantable cardioverter defibrillators under general anesthesia.


METHODS
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.


METHODS
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.


CONCLUSIONS
These substantial effects support the standard recommendation to consider the airways as an alternate route for at least 2 mg of adrenaline during resuscitation.
Raymondos
K
K
Department of Anesthesia, Medizinische Hochschule Hannover, Germany. KRaymondos@aol.com
Panning
B
B
Leuwer
M
M
Brechelt
G
G
Korte
T
T
Niehaus
M
M
Tebbenjohanns
J
J
Piepenbrock
S
S
D000042:Absorption; D000280:Administration, Inhalation; D000322:Adrenergic Agonists / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D004554:Electric Countershock; D004837:Epinephrine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000322:Adrenergic Agonists; D004837:Epinephrine