INDEX epinephrine

Epinephrine is a nonspecific a- and P-adrenergic agonist. Epinephrine can increase cardiac index and produce significant peripheral vasoconstriction. However, it can also increase lactate levels and impair blood flow to the splanchnic system. Because of these undesirable effects, epinephrine should be reserved for patients who fail to respond to traditional therapies.24,27-28... 

In a few cases, there is cause for concern that change of name could lead to confusion and constitute a public health risk, e.g. adrenaline is the BAN, epinephrine is the rINN name. In such instances, both rINN and BAN must currently appear in the manufacturer s literature. In general we use rINNs in this book and aim to minimise some unavoidable differences with, where appropriate, alternative names in the text and index. 

Recent studies have focused on the effects of dobutamine on gastric mucosal flow and the splanchnic circulation. The addition of dobutamine (held constant at 5 mcg/kg per minute) to norepinephrine improves gastric mucosal perfusion without increasing cardiac index. This is consistent with findings that dobutamine may improve pHi and mucosal perfusion in septic patients. The addition of dobutamine to epinephrine-treated patients has been shown to improve gastric mucosal perfusion, as measured by improvements in pHi, arterial lactate concentrations, and PCO2 gap. Duranteau and colleagues ... 

Agents commonly considered for vasopressor or inotropic support include dopamine, dobutamine, norepinephrine, phenylephrine, and epinephrine (Table 117 ). Dopamine, an a- and -adrenergic agent with dopaminergic activity, appears to increase MAP effectively in patients who remain hypotensive with reduced cardiac function after aggressive fluid resuscitation. Thus it is often the initial choice in sepsis because of combined vasopressor and inotropic effects. While low-dose dopamine (1 to 5 mcg/kg per minute) is effective in maintaining renal perfnsion, higher doses (>5 mcg/kg per minute) exhibit a and f) activity and are used frequently to support blood pressure and to improve cardiac function such as an increase in cardiac index (Cl). 

Hydropathy plot. The hydropathic index is plotted on they axis, with hydrophobic domains at the top and hydrophilic domains at the bottom. The x axis shows the amino-acid residue number from the amino to the carboxy terminus. The protein shown is a 7-transmembrane receptor (the serotonin receptor), analogous to the epinephrine (adrenalin) receptor. The approximate positions of the seven transmembrane segments are indicated by the purple bars. (Original plot graciously provided by... 

Yotsui T, Kitamura A, Ogawa R. Addition of epinephrine to inttathecal tetracaine augments depression of the bispectral index during intraoperative propofol sedation. J Anesth (2004) 18, 147-50. 

Fever elevates the blood GSH index (17-20). The degree of temperature elevation and the duration of hyperpyrexia cannot be correlated with the level of the GSH concentration. The mechanism underlying this effect of fever is not known the coincident elevated metabolic rate is not responsible because experimental hjrperthyroidism in animals lowers the blood GSH index (21-25). Stress in a general sense is perhaps a factor since electric and insulin shock therapies both raise the index after 2 to 6 hr., as do injections of epinephrine and insulin following a similar time interval (26-29). However, ACTH injections in normal man may cause no change or may lower the GSH concentration (30-38). The elevating effect of fever might simply be related to accelerated protein catabolism. 

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