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Medicina (Kaunas, Lithuania) 2006Epinephrine is an adrenergic agonist used to treat bronchospasm, anaphylactic reactions, bradycardia, cardiac arrest, and hypotension. Its toxicity is usually caused by... (Review)
Review
Epinephrine is an adrenergic agonist used to treat bronchospasm, anaphylactic reactions, bradycardia, cardiac arrest, and hypotension. Its toxicity is usually caused by iatrogenic errors. In overdose there is a typical rapid onset of agitation, hypertension, tachycardia, and dysrhythmias. This review article focuses on the causes of overdose, signs and symptoms, treatment and expected course, and prognosis of this iatrogenic pathology.
Topics: Adrenergic Agonists; Anaphylaxis; Arrhythmias, Cardiac; Bradycardia; Bronchial Spasm; Drug Overdose; Epinephrine; Heart Arrest; Humans; Hypertension; Hypotension; Iatrogenic Disease; Prognosis; Pulmonary Edema; Shock, Cardiogenic; Tachycardia
PubMed: 16861845
DOI: No ID Found -
European Annals of Allergy and Clinical... Jan 2021Anaphylaxis is the most severe systemic hypersensitivity reaction, and it can be life-threatening or even fatal. It involves the activation of multiple immune and non... (Review)
Review
Anaphylaxis is the most severe systemic hypersensitivity reaction, and it can be life-threatening or even fatal. It involves the activation of multiple immune and non immune pathways beyond IgE, thus exhibiting different phenotypes. New symptoms of hypersensitivity caused by chemotherapy drugs, monoclonal antibodies, and biological agents have been suggested to be recognized as anaphylaxis phenotypes. No biomarker has been described that allows an unequivocal diagnosis of anaphylaxis. Moreover, more biomarkers for specific endotypes are needed to stratify severity, to predict risk, and to optimaze tretament choice in the individual patient. Food, drugs and stinging insects represent the most commly identified triggers. Idiopathic anaphylaxis is a diagnosis of exclusion and it can hide a clonal mast cell disorder. Individual risk factors and co-factors may influence the severity of anaphylaxis or its onset, and they should be identified to implement the appropriate measures to prevent recurrence. Prompt recognition and treatment are critical in anaphylaxis, adrenaline being the first-line saving therapy. Individualized anaphylaxis action plan should include avoidance measures, prescription of an adrenaline autoinjector, education, optimal management of relevant comorbidities, venom specific immunotherapy, food oral immunotherapy, and drug desensitization, when appropriate. However, the quality of acute and long-term anaphylaxis management is variable influencing the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but they often prove challenging to implement in routine clinical care.
Topics: Allergens; Anaphylaxis; Biomarkers; Desensitization, Immunologic; Epinephrine; Humans; Pharmaceutical Preparations
PubMed: 32550734
DOI: 10.23822/EurAnnACI.1764-1489.158 -
The Journal of Allergy and Clinical... Apr 2023International guidelines stipulate that intramuscular (IM) epinephrine (adrenaline) is the first-line treatment for anaphylaxis, with an established good safety profile.... (Review)
Review
International guidelines stipulate that intramuscular (IM) epinephrine (adrenaline) is the first-line treatment for anaphylaxis, with an established good safety profile. The availability of epinephrine autoinjectors (EAI) has greatly facilitated the lay administration of IM epinephrine in community settings. However, key areas of uncertainty remain around epinephrine usage. These include variations in prescribing EAI, what symptoms should prompt epinephrine administration, whether emergency medical services (EMS) need to be contacted after administration, and whether epinephrine administered via EAI reduces mortality from anaphylaxis or improves quality of life measures. We provide a balanced commentary on these issues. There is increasing recognition that a poor response to epinephrine, particularly after 2 doses, is a useful marker of severity and the need for urgent escalation. It is likely that patients who respond to a single epinephrine dose do not require EMS activation or emergency department transfer, but data are needed to demonstrate the safety of this approach. Lastly, patients at risk of anaphylaxis must be counseled against over-reliance on EAI alone.
Topics: Humans; Anaphylaxis; Quality of Life; Epinephrine; Emergency Medical Services; Emergency Service, Hospital; Injections, Intramuscular
PubMed: 36796511
DOI: 10.1016/j.jaip.2023.02.002 -
Critical Care (London, England) May 2018Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies... (Review)
Review
Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies have shown that it impairs cerebral microcirculatory flow. It is possible that better short-term survival comes at the cost of worse long-term outcomes. This narrative review summarises the rationale for using adrenaline, significant studies to date, and ongoing research.
Topics: Epinephrine; Humans; Microcirculation; Propensity Score; Resuscitation; Treatment Outcome
PubMed: 29843791
DOI: 10.1186/s13054-018-2058-1 -
Clinical Medicine (London, England) Jul 2022Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised by the rapid development of airway...
Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised by the rapid development of airway and/or breathing and/or circulation problems. Intramuscular adrenaline is the most important treatment, although, even in healthcare settings, many patients do not receive this intervention contrary to guidelines. The Resuscitation Council UK published an updated guideline in 2021 with some significant changes in recognition, management, observation and follow-up of patients with anaphylaxis. This is a concise version of the updated guideline.
Topics: Anaphylaxis; Emergency Treatment; Epinephrine; Humans; Resuscitation
PubMed: 35882481
DOI: 10.7861/clinmed.2022-0073 -
Critical Care (London, England) Mar 2023Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) to improve...
BACKGROUND
Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) to improve coronary perfusion and attain return of spontaneous circulation (ROSC). The DBP response to epinephrine during pediatric CPR and its association with outcomes have not been well described. Thus, the objective of this study was to measure the association between change in DBP after epinephrine administration during CPR and ROSC.
METHODS
This was a prospective multicenter study of children receiving ≥ 1 min of CPR with ≥ 1 dose of epinephrine and evaluable invasive arterial BP data in the 18 ICUs of the ICU-RESUS trial (NCT02837497). Blood pressure waveforms underwent compression-by-compression quantitative analysis. The mean DBP before first epinephrine dose was compared to mean DBP two minutes post-epinephrine. Patients with ≥ 5 mmHg increase in DBP were characterized as "responders."
RESULTS
Among 147 patients meeting inclusion criteria, 66 (45%) were characterized as responders and 81 (55%) were non-responders. The mean increase in DBP with epinephrine was 4.4 [- 1.9, 11.5] mmHg (responders: 13.6 [7.5, 29.3] mmHg versus non-responders: - 1.5 [- 5.0, 1.5] mmHg; p < 0.001). After controlling for a priori selected covariates, epinephrine response was associated with ROSC (aRR 1.60 [1.21, 2.12]; p = 0.001). Sensitivity analyses identified similar associations between DBP response thresholds of ≥ 10, 15, and 20 mmHg and ROSC; DBP responses of ≥ 10 and ≥ 15 mmHg were associated with higher aRR of survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1-3 or no worsening from baseline).
CONCLUSIONS
The change in DBP following epinephrine administration during pediatric in-hospital CPR was associated with return of spontaneous circulation.
Topics: Child; Humans; Cardiopulmonary Resuscitation; Heart Arrest; Prospective Studies; Epinephrine; Blood Pressure
PubMed: 36915182
DOI: 10.1186/s13054-023-04399-5 -
Ugeskrift For Laeger Apr 2024Perioperative anaphylaxis is rare and the diagnosis is difficult to distinguish from normal side effects from anaesthesia. Anaesthetists should be able to diagnose...
Perioperative anaphylaxis is rare and the diagnosis is difficult to distinguish from normal side effects from anaesthesia. Anaesthetists should be able to diagnose anaphylaxis and treat promptly with adrenaline and fluids. Allergy investigation should be performed subsequently. This is a case report of perioperative anaphylaxis to propofol. Propofol contains refined soya oil and egg lecithin, but no connection between allergy to soy, egg or peanut and allergy to propofol has been proven, and international guidelines recommend that propofol can be used in patients with these food allergies.
Topics: Humans; Anaphylaxis; Propofol; Anesthetics, Intravenous; Drug Hypersensitivity; Female; Epinephrine; Male
PubMed: 38704709
DOI: 10.61409/V11230746 -
Critical Care (London, England) Mar 2023The Chain of Survival highlights the effectiveness of early recognition of cardiac arrest and call for help, early cardiopulmonary resuscitation and early... (Review)
Review
The Chain of Survival highlights the effectiveness of early recognition of cardiac arrest and call for help, early cardiopulmonary resuscitation and early defibrillation. Most patients, however, remain in cardiac arrest despite these interventions. Drug treatments, particularly the use of vasopressors, have been included in resuscitation algorithms since their inception. This narrative review describes the current evidence base for vasopressors and reports that adrenaline (1 mg) is highly effective at achieving return of spontaneous circulation (number needed to treat 4) but is less effective on long-term outcomes (survival to 30 days, number needed to treat 111) with uncertain effects on survival with a favourable neurological outcome. Randomised trials evaluating vasopressin, either as an alternative to or in addition to adrenaline, and high-dose adrenaline have failed to find evidence of improved long-term outcomes. There is a need for future trials to evaluate the interaction between steroids and vasopressin. Evidence for other vasopressors (e.g. noradrenaline, phenylephedrine) is insufficient to support or refute their use. The use of intravenous calcium chloride as a routine intervention in out of hospital cardiac arrest is not associated with benefit and may cause harm. The optimal route for vascular access between peripheral intravenous versus intraosseous routes is currently the subject of two large randomised trials. Intracardiac, endobronchial, and intramuscular routes are not recommended. Central venous administration should be limited to patients where an existing central venous catheter is in situ and patent.
Topics: Humans; Epinephrine; Heart; Norepinephrine; Out-of-Hospital Cardiac Arrest; Vasoconstrictor Agents; Heart Arrest
PubMed: 36864469
DOI: 10.1186/s13054-023-04301-3 -
Chinese Medical Journal Sep 2017Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. The evidence for the use of adrenaline in... (Review)
Review
OBJECTIVE
Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive. We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients.
DATA SOURCES
The EMBASE and PubMed databases were searched with the key words "epinephrine," "cardiac arrest," and variations of these terms.
STUDY SELECTION
Data from clinical randomized trials, meta-analyses, guidelines, and recent reviews were selected for review.
RESULTS
Sudden cardiac arrest causes 544,000 deaths in China each year, with survival occurring in <1% of cases (compared with 12% in the United States). The American Heart Association recommends the use of epinephrine in patients with cardiac arrest, as part of advanced cardiac life support. There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC). However, there are conflicting results regarding long-term survival and functional recovery, particularly neurological outcome, after CPR. There is currently insufficient evidence to support or reject epinephrine administration during resuscitation. We believe that epinephrine may have a role in resuscitation, as administration of epinephrine during CPR increases the probability of restoring cardiac activity with pulses, which is an essential intermediate step toward long-term survival.
CONCLUSIONS
The administration of adrenaline was associated with improved short-term survival (ROSC). However, it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA, and it may have a harmful effect. Larger placebo-controlled, double-blind, randomized control trials are required to definitively establish the effect of epinephrine.
Topics: Cardiopulmonary Resuscitation; Epinephrine; Humans; Meta-Analysis as Topic; Out-of-Hospital Cardiac Arrest; Randomized Controlled Trials as Topic
PubMed: 28836556
DOI: 10.4103/0366-6999.213429 -
Ugeskrift For Laeger May 2014Anaphylaxis is a potentially life-threatening systemic allergic reaction involving several organ systems. Recognition of the reaction leading to prompt treatment is... (Review)
Review
Anaphylaxis is a potentially life-threatening systemic allergic reaction involving several organ systems. Recognition of the reaction leading to prompt treatment is essential for a good outcome. The lifesaving treatment is intramuscular injection of adrenaline (0.3-0.5 mg for adults and children > 40 kg, 0.3 mg for children 20-40 kg and 0.15 mg for infants < 20 kg). The patient must be placed on the back with elevated lower extremities to improve cerebral and cardiac circulation. High dose oxygen and crystalloid fluid load are needed to improve oxygenation and cardiac output.
Topics: Adult; Algorithms; Anaphylaxis; Child; Diagnosis, Differential; Epinephrine; Humans
PubMed: 25352003
DOI: No ID Found