Epinephrine adrenaline

Epinephrine is an endogenous catecholamine secreted by the adrenal medulla. It is a potent a- and b -,-agonist and a moderate b2-agonist. Its effects are dose dependent, with b effects predominating at lower doses (0.04-0.1 pg/kg/min), resulting in increased heart rate, cardiac output, and contractility. The increased contractility may result in myocardial ischemia and arrhythmias, and this limits its use. At higher doses a effects become more prominent, raising peripheral resistance and blood pressure. Recent studies in critically ill patients suggest that epinephrine may reduce splanchnic blood flow more than other adrenergic agents (Meier-Hellmannand Rei.nha.rt 19,9.4).

Indications Cardiac arrest

During cardiopulmonary resuscitation, epinephrine can be administered as a repeated intravenous bolus of 1 mg every 3 to 5 min. As it is absorbed well through the airway mucosa, it can be administered through the endotracheal tube (diluted in 10 ml of sterile water or saline) if venous access is difficult.

Acute anaphylaxis

Epinephrine is the agent of choice as it antagonizes the bronchoconstriction and vasodilation associated with anaphylaxis. It can be administered as a subcutaneous bolus (0.1-0.5 mg) or as a continuous infusion (0.01-0.3 mg/min).

Cardiogenic shock

Epinephrine can be added as a continuous infusion when dopamine or dobutamine have failed to restore minimal perfusion pressure. This occurs in the most severe situations close to cardiopulmonary resuscitation. In some intensive care units (ICUs), epinephrine is administered in other forms of acute circulatory failure as a substitute for dopamine, primarily because of its lower cost, but dopamine is probably preferable.

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