title: Absorption and hemodynamic effects of airway administration of adrenaline in patients with severe cardiac disease.
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.
  
  
  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.
authors.affiliation: Department of Anesthesia, Medizinische Hochschule Hannover, Germany. KRaymondos@aol.com
authors.forename: K
authors.initials: K
authors.lastname: Raymondos
authors.forename: B
authors.initials: B
authors.lastname: Panning
authors.forename: M
authors.initials: M
authors.lastname: Leuwer
authors.forename: G
authors.initials: G
authors.lastname: Brechelt
authors.forename: T
authors.initials: T
authors.lastname: Korte
authors.forename: M
authors.initials: M
authors.lastname: Niehaus
authors.forename: J
authors.initials: J
authors.lastname: Tebbenjohanns
authors.forename: S
authors.initials: S
authors.lastname: Piepenbrock
mesh_terms: 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
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine