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Absorption and Hemodynamic Effects of Airway Administration of Adrenaline in Patients with Severe Cardiac Disease

Konstantinos Raymondos, MD; Bernhard Panning, MD; Martin Leuwer, MD; Guido Brechelt; Thomas Korte, MD; Michael Niehaus, MD; Jürgen Tebbenjohanns, MD; and Siegfried Piepenbrock, MD
[+] Article and Author Information

From Medical School Hannover, Hannover, Germany.


Acknowledgments: The authors thank Dr. H.A. Adams for adrenaline and noradrenaline determination and Dr. Hartmut Hecker for his assistance with biostatistical analysis.

Grant Support: By institutional funding from Förderkreis für Fortbildung und Forschung in der Anästhesie, Intensivmedizin, Schmerztherapie und Notfallmedizin der Medizinischen Hochschule Hannover e.V.

Requests for Single Reprints: Konstantinos Raymondos, MD, Department of Anesthesia, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; e-mail, KRaymondos@aol.com.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Raymondos, Panning, Leuwer, and Piepenbrock and Mr. Brechelt: Department of Anesthesia, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany.

Drs. Korte, Niehaus, and Tebbenjohanns: Department of Cardiology, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany.

Author Contributions: Conception and design: K. Raymondos, B. Panning.

Analysis and interpretation of the data: K. Raymondos, B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, S. Piepenbrock.

Drafting of the article: K. Raymondos, B. Panning, T. Korte.

Critical revision of the article for important intellectual content: B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, S. Piepenbrock.

Final approval of the article: K. Raymondos, B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, S. Piepenbrock.

Obtaining of funding: K. Raymondos.

Administrative, technical, or logistic support: B. Panning, J. Tebbenjohanns, S. Piepenbrock.

Collection and assembly of data: K. Raymondos, B. Panning, G. Brechelt.


Ann Intern Med. 2000;132(10):800-803. doi:10.7326/0003-4819-132-10-200005160-00007
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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.

Design: Prospective clinical trial.

Setting: Operating theater at university hospital.

Patients: 34 patients receiving implantable cardioverter defibrillators under general anesthesia.

Intervention: 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.

Measurements: 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.

Conclusion: These substantial effects support the standard recommendation to consider the airways as an alternate route for at least 2 mg of adrenaline during resuscitation.

Figures

Grahic Jump Location
Figure.
Effect of adrenaline on mean arterial blood pressure. Top.CVETBottom.PB

Time course of mean arterial blood pressure in 17 patients after central intravenous administration of adrenaline ( ) and administration directly into the endotracheal tube ( ). Time course of mean arterial blood pressure in 17 patients after central intravenous administration of adrenaline and peripheral bronchial ( ) administration through a wedged catheter. Boldface lines represent the median.

Grahic Jump Location

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Summary for Patients

The Effect on Blood Pressure of Putting Large Doses of Adrenaline into the Airways

The summary below is from the full report titled “Absorption and Hemodynamic Effects of Airway Administration of Adrenaline in Patients with Severe Cardiac Disease.” It is in the 16 May 2000 issue of Annals of Internal Medicine (volume 132, pages 800-803). The authors are K. Raymondos, B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, and S. Piepenbrock.

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