title: Hemodynamics after endoscopic submucosal injection of epinephrine in a porcine model.
abstract: OBJECTIVE
  Endoscopic submucosal injection of epinephrine may cause systemic effects on the cardiovascular system. The aim of this experimental study was to assess systemic hemodynamic changes after submucosal injection of epinephrine during upper gastrointestinal endoscopy in a porcine model.
  
  
  METHODS
  Measurements were taken from 12 pigs under general anesthesia. During gastroscopy 5 mL of normal saline, and 2.5 mL and 5 mL of epinephrine (1:10,000) were injected into the submucosal layers of the gastric antrum, corpus, and distal esophagus. After each injection, the cardiac index and global end diastolic volume index (GEDVI, reflecting preload) were measured every 3 minutes by transpulmonary thermodilution for a minimum of 12 minutes. The following parameters were also recorded: heart rate, mean arterial pressure (MAP), and systemic vascular resistance index (SVRI, reflecting afterload).
  
  
  RESULTS
  Significant hemodynamic changes were observed after submucosal injection of epinephrine into the esophagus, including heart rate (maximum + 4 %) and MAP (maximum - 4%) after injection of 2.5 mL epinephrine, and stronger changes in heart rate (maximum +13%), cardiac index (maximum +21%), MAP (maximum -4%), and SVRI (maximum -12%) after the injection of 5 mL epinephrine. After submucosal injection of epinephrine into the gastric antrum and corpus, hemodynamic effects were less evident. Here significant changes were observed in heart rate (maximum +3%), MAP (maximum -2%), cardiac index (maximum +7%), and SVRI (maximum -8%) only after the injection of 5 mL epinephrine into the antrum.
  
  
  CONCLUSIONS
  Endoscopic submucosal injection of epinephrine is associated with changes in systemic hemodynamic parameters, especially when performed in the esophagus, and the procedure might therefore induce harmful side effects.
authors.affiliation: Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schlag
authors.forename: A
authors.initials: A
authors.lastname: Karagianni
authors.forename: M
authors.initials: M
authors.lastname: Grimm
authors.forename: M
authors.initials: M
authors.lastname: Stangassinger
authors.forename: T
authors.initials: T
authors.lastname: Schuster
authors.forename: W
authors.initials: W
authors.lastname: Huber
authors.forename: R M
authors.initials: RM
authors.lastname: Schmid
authors.forename: A
authors.initials: A
authors.lastname: Meining
authors.forename: S
authors.initials: S
authors.lastname: von Delius
mesh_terms: D000818:Animals; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D004947:Esophagus; D005260:Female; D005753:Gastric Mucosa; D005773:Gastroscopy; D006439:Hemodynamics / Q000187:drug effects*; D007267:Injections; D011446:Prospective Studies; D013552:Swine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine