Adrenaline intravenous infusion

Noradrenaline and adrenaline are the classic catecholamines and neurotransmitters in the sympathetic nervous system. Noradrenaline stimulates the following subtypes of adrenoceptors P, a, U2. It has positive inotropic and chronotropic activities as a result of /3i-receptor stimulation. In addition, it is a potent vasoconstrictor agent as a result of the stimulation of both subtypes (ai,a2) of a-adrenoceptors. After intravenous infusion, its effects develop within a few minutes, and these actions disappear within 1-2 minutes after stopping the infusion. It may be used in conditions of acute hypotension and shock, especially in patients with very low vascular resistance. It is also frequently used as a vasoconstrictor, added to local anaesthetics. Adrenaline stimulates the following subtypes of adrenoceptors /3i, P2, oil, 0L2. Its pharmacological profile greatly resembles that of noradrenaline (see above), as well as its potential applications in shock and hypotension. Like noradrenaline, its onset and duration of action are very short, as a result of rapid inactivation in vivo. Both noradrenaline and adrenaline may be used for cardiac stimulation. Their vasoconstrictor activity should be kept in mind. A problem associated with the use of /3-adrenoceptor stimulants is the tachyphylaxis of their effects, explained by the /3-adrenoceptor downregulation, which is characteristic for heart failure. 

Warfarin sodium may be adsorbed to PVC and intravenous infusion sets but may be minimized with glass containers or polyethylene-lined containers. Warfarin sodium is incompatible with solutions of adrenaline hydrochloride, amikacin sulfate, metaraminol tartrate, oxytocin, promazine hydrochloride, tetracycline hydrochloride, aminophylline, bretylium tosylate, ceftazidime, cimetidine hydrochloride, ciprofloxacin lactate, dobutamine hydrochloride, esmolol hydrochloride, gentamicin sulfate, labetalol hydrochloride, metronidazole hydrochloride, and vancomycin hydrochloride.130131... 

The fruit body of Ganoderman lucidum (Fr.) Karst has been used for the treatment of hypertension, hyperlipidemia, arthritis, bronchitis, arteriosclerosis, diabetes and cancer. I previously reported that an aqueous extract of G lucidum reduced the elevation of blood glucose without elevating blood insulin in a test utilizing an intravenous infusion of adrenaline and an oral infusion of glucose [4], The polysaccharide... 

The effects of intravenous infusions of noradrenaline (norepinephrine) were increased approximately ninefold, and of adrenaline (epinephrine) approximately threefold, in 6 healthy subjects who had been taking protriptyline 60 mg daily for 4 days. > ... 

The pressor effects of intravenous infusions of noradrenaline were increased four to eightfold, of adrenaline two to fourfold, and of phenylephrine two to threefold in 4 healthy subjects who had been taking imipramine 75 mg daily for 5 days. There were no noticeable or consistent changes in their response to isoprenaline (isoproterenol). However, in a study of possible adverse interactions between imipramine and isoprenaline, although no abnormalities of heart rhythm were seen, one out of the 4 healthy subjects studied showed potentiation of isoprenaline- induced tachycardia. ... 

Maintaining a deep anterior chamber can be considered the conditio sine qua non for successful anterior segment intraocular surgery. There are diverse pre- and intraoperative precautionary measures available to achieve this oculopression, addition of adrenalin and hyaluronidase to retrobulbar anesthesia, hyperventilation and blood pressure reduction during anesthesia, closed system operation as made possible by phacoemulsification (lens nucleus disintegration via ultrasound), or by intravenous infusion of hyperosmolar substances (Voros-marthy, 1967 Kelman, 1967). 

Intravenous infusions of 0-3-2-0 /ig per 100 g body weight per minute of noradrenaline increased respiratory metabolism in rats (Hannon and Larson (1821). Ankermann 1822)) g uer and Lembeck found after subcutaneous injections of 30, 60, or 120 fig noradrenaline per 100 g body weight— metabolic increases of about the same degree as after adrenaline the effect of noradrenaline occurred more quickly, but that of adrenaline lasted longer. ... 

A 73-year-old man developed shivering and spasm 25 minutes into an intravenous infusion of Xing nao jing injection 20 ml in isotonic saline 250 ml for cerebral infarction. The infusion was stopped immediately. He gradually recovered 40 minutes later after receiving oxygen, adrenaline, and promethazine. 

A 32-year-old woman, a smoker, had an evacuation after the death of her fetus at 18 weeks. Two pessaries of gemeprost 1 mg were inserted 7.25 hours apart, and about 90 minutes later she became unconscious, apneic, and cyanotic, and had dilated pupils and no detectable blood pressure or pulse. She was given 100% oxygen, intravenous adrenaline and dobutamine, and a crystalloid infusion. Her systolic pressure rose to 100 mmHg. Coronary angiography showed left and circumflex coronary artery spasm. 

Dose. For local anaesthesia, the total dose of lignocaine hydrochloride by injection should not exceed 300 mg (4.5 mg/kg), unless administered with adrenaline. For ventricular arrhythmias, initally 50 to 100 mg intravenously, followed by an infusion. 

A 65-year-old man undergoing elective sternal debridement and rewiring was given a prophylactic infusion of vancomycin 1 g preoperatively. Anesthesia was induced with thiopental, suxamethonium, and fentanyl, and maintained with fentanyl, vecuronium, and isoflurane. A few minutes after wound irrigation with bacitracin (about 25U/ml), his blood pressure fell precipitously, necessitating intravenous fluids and adrenaline. His face and arms were flushed. Afterwards, he reported having had a rash several years before after the use of an over-the-counter ointment composed of polymyxin B, bacitracin, and neomycin. 

An anaphylactic reaction occurred in a 77-year-old woman 5 minutes after the start of a vancomycin infusion, when she had received only 40 mg (88). She became unconscious and had a severe cardiovascular collapse, from which she was resuscitated with intravenous ephedrine and adrenaline. 

A man taking prazosin (5 mg three times daily for hypertension) developed marked hypotension (BP 60/40 mmHg) within 3 to 5 minutes of receiving 100 mg of bupivacaine through an L3-4 lumbar epidural catheter. He was unresponsive to intravenous phenylephrine (five 100-microgram boluses) but his blood pressure rose within 3 to 5 minutes of starting an infusion of adrenaline (epinephrine) 0.05 micrograms/kg per minute. 

Vedung T, Jorfeldt L, Henriksson J. Intravenous adrenaline infusion causes vasoconstriction close to an intramuscular microdialysis catheter in humans. Clin Physiol Funct Imaging 2010 30(6) 399-405. 

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