title: A comparison of epinephrine only, arginine vasopressin only, and epinephrine followed by arginine vasopressin on the survival rate in a rat model of anaphylactic shock.
abstract: BACKGROUND
  Epinephrine and more recently arginine vasopressin (AVP) alone or in combination have been proposed in patients with anaphylactic shock, but few experimental data exist. The authors investigated the effects of epinephrine only, AVP only, or epinephrine followed by AVP in a model of anaphylactic shock.
  
  
  METHODS
  Ovalbumin-sensitized Brown Norway rats were anesthetized, intubated, and shock induced with ovalbumin. Rats (n = 6/group) were randomly allocated to receive 5 min after shock onset: (1) saline (no-treatment group); (2) two boluses of epinephrine followed by continuous infusion (epinephrine group); (3) AVP bolus followed by continuous infusion (AVP group); (4) epinephrine bolus followed by AVP continuous infusion (epinephrine + AVP group). Mean arterial pressure (MAP) and skeletal muscle oxygen pressure (PtiO2) were measured. Continuous infusion rates were titrated to reach MAP values of 60 mmHg. Survival was analyzed.
  
  
  RESULTS
  Without treatment, MAP and PtiO2 decreased rapidly with 0% survival. In the epinephrine group, MAP and PtiO2 recovered after an initial decrease, with 84% survival. In the AVP group, MAP was partially restored and subsequently decreased; PtiO2 values decreased to values similar to those in the no-treatment group; survival was 0%. In the epinephrine + AVP group, MAP and PtiO2 values increased more slowly as compared with the epinephrine group; survival was 100%.
  
  
  CONCLUSIONS
  In this model of anaphylactic shock, early treatment with epinephrine followed by continuous epinephrine or vasopressin infusion resulted in an excellent survival rate, whereas vasopressin only resulted in a 100% death rate. These experimental results suggest that epinephrine must still be considered as the first-line drug to treat anaphylactic shock.
authors: Pôle d'Anesthésie-Réanimation, Centre Hospitalier Universitaire, Nancy, France.
authors: Pascale
authors: P
authors: Dewachter
authors: Isabelle
authors: I
authors: Raëth-Fries
authors: Valérie
authors: V
authors: Jouan-Hureaux
authors: Patrick
authors: P
authors: Menu
authors: Claude
authors: C
authors: Vigneron
authors: Dan
authors: D
authors: Longrois
authors: Paul Michel
authors: PM
authors: Mertes
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy* / Q000401:mortality; D000818:Animals; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D051381:Rats; D011914:Rats, Inbred BN; D015996:Survival Rate; D015431:Weight Loss
chemical_list: D001127:Arginine Vasopressin; D004837:Epinephrine