Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data.

PubMed

Warren, Sam A; Huszti, Ella; Bradley, Steven M; Chan, Paul S; Bryson, Chris L; Fitzpatrick, Annette L; Nichol, Graham

2014-03-01

Expert guidelines for treatment of cardiac arrest recommend administration of adrenaline (epinephrine) every three to five minutes. However, the effects of different dosing periods of epinephrine remain unclear. We sought to evaluate the association between epinephrine average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest (IHCA). We performed a retrospective review of prospectively collected data on 20,909 IHCA events from 505 hospitals participating in the Get With The Guidelines-Resuscitation (GWTG-R) quality improvement registry. Epinephrine average dosing period was defined as the time between the first epinephrine dose and the resuscitation endpoint, divided by the total number of epinephrine doses received subsequent to the first epinephrine dose. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. Compared to a referent epinephrine average dosing period of 4 to <5 min per dose, survival to hospital discharge was significantly higher in patients with the following epinephrine average dosing periods: for 6 to <7 min/dose, adjusted odds ratio [OR], 1.41 (95%CI: 1.12, 1.78); for 7 to <8 min/dose, adjusted OR, 1.30 (95%CI: 1.02, 1.65); for 8 to <9 min/dose, adjusted OR, 1.79 (95%CI: 1.38, 2.32); for 9 to <10 min/dose, adjusted OR, 2.17 (95%CI: 1.62, 2.92). This pattern was consistent for both shockable and non-shockable cardiac arrest rhythms. Less frequent average epinephrine dosing than recommended by consensus guidelines was associated with improved survival of in-hospital cardiac arrest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Effect of vehicle on the nasal absorption of epinephrine during cardiopulmonary resuscitation.

PubMed

Bleske, B E; Rice, T L; Warren, E W; Giacherio, D A; Gilligan, L J; Massey, K D; Chrisp, C E; Tait, A R

1996-01-01

We have shown in previous studies that epinephrine administered intranasally is a feasible route of administration during cardiopulmonary resuscitation (CPR). To promote the absorption of epinephrine we administered phentolamine prior to epinephrine and used a bile salt as a vehicle to dissolve the epinephrine. The purpose of this study was to compare the effect of two different vehicles (bile salt vs surfactant) in promoting the absorption of nasally administered epinephrine during CPR and to determine their effects on the nasal mucosa. A randomized, blinded study. A controlled laboratory environment. Eleven mongrel dogs. Each dog underwent 3 minutes of unassisted ventricular fibrillation (VF) followed by 7 minutes of VF with CPR. Five minutes after the start of VF, 10 dogs received intranasal phentolamine 0.25 mg/kg/nostril followed 1 minute later by intranasal epinephrine 7.5 mg/kg/nostril. The epinephrine was dissolved in a randomly assigned vehicle consisting of either taurodeoxycholic acid (group A, bile salt) or polyoxyethylene-9-lauryl ether (group B, surfactant). One animal acted as a control and received 0.9% sodium chloride nasally. Data from eight dogs (one control) were included for analysis. Histology of the nasal cavity demonstrated severe multifocal erosion and ulceration of the respiratory epithelium for groups A and B compared with the control. The severity was similar between the two groups. In addition, no significant differences in plasma epinephrine concentrations or blood pressure responses were seen between the groups. Based on histology, polyoxyethylene-9-lauryl ether offered no advantage over taurodeoxycholic acid in its effect on the nasal mucosa. The data available for changes in epinephrine concentration and pressure also suggest no difference between the two vehicles in promoting the absorption of epinephrine during CPR in an animal model.

Phentolamine Reverses Epinephrine-Enhanced Skin Antinociception of Dibucaine in Rats.

PubMed

Chou, An-Kuo; Chiu, Chong-Chi; Chen, Yu-Wen; Wang, Jhi-Joung; Hung, Ching-Hsia

2018-05-25

The objective of the experiment was to assess the antinociceptive effect of dibucaine, bupivacaine, and epinephrine. To assess the mechanism of action of the interaction between dibucaine and epinephrine, phentolamine, a nonselective α-adrenergic antagonist, was added to the mixture. We assessed sensory blockade with these drugs by injecting 0.6 mL of drug-in-saline in the dorsal thoracolumbar area of rats; pinprick of the "wheal" formed by the injectate was the area targeted for stimulation to elicit a cutaneous trunci muscle reflex. The sensory block of dibucaine was compared with that of bupivacaine or epinephrine. Drug-drug interactions were analyzed by isobologram. Phentolamine was added to investigate the antinociceptive effect of dibucaine coinjected with epinephrine. We demonstrated that dibucaine, epinephrine, and bupivacaine produced dose-dependent skin antinociception. On the median effective dose (ED50) basis, the potency was higher for epinephrine (mean, 0.011 [95% confidence interval {CI}, 0.007-0.015] μmol) than for dibucaine (mean, 0.493 [95% CI, 0.435-0.560] μmol) (P < .01), while there were no significant differences between dibucaine and bupivacaine (mean, 0.450 [95% CI, 0.400-0.505] μmol). On the equipotent basis (75% effective dose, median effective dose, and 25% effective dose), sensory block duration provoked by epinephrine was greater (P < .01) than that provoked by dibucaine or bupivacaine. Coadministration of dibucaine with epinephrine produced a synergistic nociceptive block, whereas phentolamine blocked that synergistic block. The preclinical data indicated that there is no statistically significant difference between the potency and duration of dibucaine and bupivacaine in this model. Epinephrine synergistically enhances the effects of dibucaine, while phentolamine partially blocked those effects. α-Adrenergic receptors play an important role in controlling synergistic analgesic effect of dibucaine combined with epinephrine.

Effect of prehospital epinephrine on out-of-hospital cardiac arrest: a report from the national out-of-hospital cardiac arrest data registry in Japan, 2011-2012.

PubMed

Fukuda, Tatsuma; Ohashi-Fukuda, Naoko; Matsubara, Takehiro; Gunshin, Masataka; Kondo, Yutaka; Yahagi, Naoki

2016-10-01

The effect of prehospital epinephrine on neurological outcome in out-of-hospital cardiac arrest (OHCA) is still controversial. We sought to determine whether prehospital epinephrine administration was associated with improved outcomes in adult OHCA. A nationwide, population-based, propensity score-matched study of OHCA patients from January 1, 2011, to December 31, 2012, in Japan was conducted. We included adult OHCA patients treated by emergency medical service personnel without an excessive delay. The primary outcome was neurologically favorable survival 1 month after OHCA. A total of 237,068 patients (16,616 with a shockable rhythm and 220,452 with a non-shockable rhythm) were included in the final cohort. A total of 4024 out of the 16,616 shockable OHCAs and 29,393 out of the 220,452 non-shockable OHCAs received prehospital epinephrine. In the propensity score-matched cohort, prehospital epinephrine was associated with a decreased chance of neurologically favorable survival (shockable OHCA 7.6 vs. 17.9 %, OR 0.38 [95%CI 0.33-0.43]; non-shockable OHCA 0.6 vs. 1.2 %, OR 0.47 [95%CI 0.39-0.56]). In the subgroup analyses, prehospital epinephrine was significantly associated with poor neurological outcome in all subgroups. In the ancillary analyses, although the neurological outcome was worse as the number of epinephrine doses increased or the time to epinephrine increased, patients had a greater chance of a favorable neurological outcome only when a single dose of epinephrine was administered within 15 min of the emergency call in shockable OHCA. Among adult OHCA patients, prehospital epinephrine was associated with a decreased chance of neurologically favorable survival. Situations in which prehospital epinephrine is effective may be extremely limited.

Basic Life Support Access to Injectable Epinephrine across the United States.

PubMed

Brasted, Ian D; Dailey, Michael W

2017-01-01

 Aggressive epinephrine administration has growing support in the treatment of anaphylaxis, a life-threatening allergic reaction. Emergency Medical Services (EMS) providers are frequently in a position to provide the first care to someone experiencing an anaphylactic reaction. Intramuscular injection of epinephrine is the definitive pharmacologic treatment for many associated symptoms. While easy to use, epinephrine autoinjectors (EAI) are prohibitively expensive, having increased in price ten-fold in ten years. Some states and EMS departments have begun expanding the scope of practice to allow Basic Life Support (BLS) providers, previously restricted to noninvasive therapies, to administer epinephrine by syringe. To compile a current and comprehensive list of how epinephrine is carried and used by EMS across the USA. An online survey focusing on anaphylaxis protocols and epinephrine administration was sent to state EMS medical directors and officials in all 50 states. Follow-up telephone calls were made to ensure compliance. Data were analyzed with descriptive statistics. Forty-nine of the 50 states in the USA provided a survey response. Texas responded but declined to participate in the survey because of practice variability across the state. In the other states, the form of epinephrine allowed or required on BLS ambulances was consistent with the scope of practice of their Basic Emergency Medical Technician (EMT). Thirteen states had training programs to allow BLS providers to inject epinephrine; 7 were considering it; 29 were not. Twenty-seven states specified EAI as the only form of epinephrine required or allowed on their BLS ambulances. No states reported allowing any level of EMS provider below EMT to use alternatives to EAI. This study confirms that many states have expanded the training of BLS providers to include the use of syringe injectable epinephrine. Even so, the majority of states relied on EAI in BLS ambulances.

Effects of prehospital epinephrine administration on neurologically intact survival in bystander-witnessed out-of-hospital cardiac arrest patients with non-shockable rhythm depend on prehospital cardiopulmonary resuscitation duration required to hospital arrival.

PubMed

Funada, Akira; Goto, Yoshikazu; Tada, Hayato; Shimojima, Masaya; Hayashi, Kenshi; Kawashiri, Masa-Aki; Yamagishi, Masakazu

2018-06-23

The effects of prehospital epinephrine administration on post-arrest neurological outcome in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm remain unclear. To examine the time-dependent effectiveness of prehospital epinephrine administration, we analyzed 118,396 bystander-witnessed OHCA patients with non-shockable rhythm from the prospectively recorded all-Japan OHCA registry between 2011 and 2014. Patients who achieved prehospital return of spontaneous circulation without prehospital epinephrine administration were excluded. Patients with prehospital epinephrine administration were stratified according to the time from the initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers to the first epinephrine administration (≤ 10, 11-19, and ≥ 20 min). Patients without prehospital epinephrine administration were stratified according to the time from CPR initiation by EMS providers to hospital arrival (≤ 10, 11-19, and ≥ 20 min). The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1-2). Multivariate logistic regression analysis demonstrated that there was no significant difference in the chance of 1-month CPC 1-2 between patients who arrived at hospital in ≤ 10 min without prehospital epinephrine administration and patients with time to epinephrine administration ≤ 19 min. However, compared to patients who arrived at hospital in ≤ 10 min without prehospital epinephrine administration, patients with time to epinephrine administration ≥ 20 min and patients who arrived at hospital in 11-19, and ≥ 20 min without prehospital epinephrine administration were significantly associated with decreased chance of 1-month CPC 1-2 (p < 0.05, < 0.05, and < 0.001, respectively). In conclusion, when prehospital CPR duration from CPR initiation by EMS providers to hospital arrival estimated to be ≥ 11 min, prehospital epinephrine administered ≤ 19 min from CPR initiation by EMS providers could improve neurologically intact survival in bystander-witnessed OHCA patients with non-shockable rhythm.

Epinephrine increases contextual learning through activation of peripheral β2-adrenoceptors.

PubMed

Alves, Ester; Lukoyanov, Nikolay; Serrão, Paula; Moura, Daniel; Moreira-Rodrigues, Mónica

2016-06-01

Phenylethanolamine-N-methyltransferase knockout (Pnmt-KO) mice are unable to synthesize epinephrine and display reduced contextual fear. However, the precise mechanism responsible for impaired contextual fear learning in these mice is unknown. Our aim was to study the mechanism of epinephrine-dependent contextual learning. Wild-type (WT) or Pnmt-KO (129x1/SvJ) mice were submitted to a fear conditioning test either in the absence or in the presence of epinephrine, isoprenaline (non-selective β-adrenoceptor agonist), fenoterol (selective β2-adrenoceptor agonist), epinephrine plus sotalol (non-selective β-adrenoceptor antagonist), and dobutamine (selective β1-adrenoceptor agonist). Catecholamines were separated by reverse-phase HPLC and quantified by electrochemical detection. Blood glucose was measured by coulometry. Re-exposure to shock context induced higher freezing in WT and Pnmt-KO mice treated with epinephrine and fenoterol than in mice treated with vehicle. In addition, freezing response in Pnmt-KO mice was much lower than in WT mice. Freezing induced by epinephrine was blocked by sotalol in Pnmt-KO mice. Epinephrine and fenoterol treatment restored glycemic response in Pnmt-KO mice. Re-exposure to shock context did not induce a significant difference in freezing in Pnmt-KO mice treated with dobutamine and vehicle. Aversive memories are best retained if moderately high plasma epinephrine concentrations occur at the same moment as the aversive stimulus. In addition, epinephrine increases context fear learning by acting on peripheral β2-adrenoceptors, which may induce high levels of blood glucose. Since glucose crosses the blood-brain barrier, it may enhance hippocampal-dependent contextual learning.

Assessment of the effects of epinephrine and insulin on plasma and serum biochemical variables in llamas and alpacas.

PubMed

Cebra, Christopher K; Tornquist, Susan J

2004-12-01

To describe the metabolic effects of epinephrine administration in New World camelids and investigate whether these effects are influenced by administration of insulin. 6 llamas and 8 alpacas (all adult castrated males). Prior to each experiment, food was withheld from camelids for 8 hours. On each of 2 consecutive days, alpacas were administered epinephrine (10 mg/kg, IM; time 0); alpacas were randomly assigned to receive regular insulin (0.2 U/kg, IV) immediately after epinephrine administration on one of those days. In llamas, the experiment was performed once after administration of epinephrine only. At 0, 30, 60, 90, 120, 150, 180, 210, and 240 minutes after treatment, blood samples were collected and several serum or plasma biochemical variables were assessed; in addition, plasma samples from llamas were assessed for insulin concentrations. Data were compared between days (alpacas only) and between time points. Administration of epinephrine induced mobilization of glucose, triglycerides, nonesterified fatty acids, and beta-hydroxybutyrate. A small increase in endogenous insulin concentration was detected in epinephrine-treated llamas, compared with baseline values. Overall, insulin administration decreased, negated, or delayed the epinephrine-associated increases in serum or plasma concentrations of circulating energy substrates, except that it augmented the epinephrine-associated increase in concentration of triglycerides. Epinephrine appeared to mobilize energy substrates in camelids and hence may be involved in the pathogenesis of disorders of glucose and fat metabolism. Insulin appeared to antagonize most of these effects, and its administration may have therapeutic value in camelids.

Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions

PubMed Central

Campbell, Ronna L.; Bellolio, M. Fernanda; Motosue, Megan S.; Sunga, Kharmene L.; Lohse, Christine M.; Rudis, Maria I.

2016-01-01

Introduction Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) healthcare providers regarding two methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery. Methods This observational study adhered to survey reporting guidelines. It was performed through a Web-based survey completed by healthcare providers at an academic ED. The primary outcomes were assessment of provider perceptions and identification of the preferred IM epinephrine administration method by ED healthcare providers. Results Of 217 ED healthcare providers invited to participate, 172 (79%) completed the survey. Overall, 82% of respondents preferred the autoinjector method of epinephrine administration. Providers rated the autoinjector method more favorably for time required for training, ease of use, convenience, satisfaction with weight-based dosing, risk of dosing errors, and speed of administration (p<0.001 for all comparisons). However, manual injection use was rated more favorably for risk of provider self-injury and patient cost (p<0.001 for both comparisons). Three participants (2%) reported a finger stick injury from an epinephrine autoinjector. Conclusion ED healthcare providers preferred the autoinjector method of IM epinephrine administration for the management of anaphylaxis or allergic reactions. Epinephrine autoinjector use may reduce barriers to epinephrine administration for the management of anaphylaxis in the ED. PMID:27833688

Epinephrine Enhances the Response of Macrophages under LPS Stimulation

PubMed Central

Zhou, Jianyun; Liang, Huaping; Jiang, Jianxin

2014-01-01

Trauma associated with infection may directly trigger a neuroendocrine reaction in vivo while the hormone epinephrine is known to mediate immune responses to inflammation after injury. However, the role of epinephrine during the earliest stage of trauma still remains unclear. We therefore explored the role of epinephrine on activated macrophages under LPS stimulation in vitro as well as the mechanisms underlying its effect. Dose- and time-dependent effects of epinephrine on macrophage immune function were assessed after LPS activation. We also employed CD14 siRNA interference to investigate whether CD14 played a role in the mechanism underlying the effect of epinephrine on LPS-induced macrophage responses. Our results showed that epinephrine pretreatment (10 ng/mL) significantly promoted immune responses from LPS stimulated macrophages, including phagocytic rate, phagocytic index, TNFα/IL-1β/IL-10 secretion, and CD14 expression (P < 0.05). Moreover, TNFα/IL-1β/IL-10 levels attained their peak value 1 hour after incubation with 10 ng/mL epinephrine (P < 0.05), and CD14 siRNA transfection dramatically decreased phagocytosis and cytokine secretion by LPS-activated macrophages (P < 0.05). We therefore conclude that 10 ng/mL epinephrine enhances immune responses from macrophages under LPS stimulation and that the underlying mechanism may relate to CD14 upregulation on the surface of macrophages. PMID:25243125

[Time to bury the adrenaline-myth!--Safe use of adrenaline anesthesia in hand surgery and orthopedics].

PubMed

Hagert, Elisabet; Lalonde, Donald

2015-02-03

The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or "bloodless field". Surgery using Wide Awake, Lidocaine-epinephrine Anesthesia, No Tourniquet (WALANT) reduces patient discomfort, facilitates patient participation in surgery, improves safe outcomes following reconstructions and greatly reduces the cost of medical care. Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.

Hospital Variation in Time to Epinephrine for Non-Shockable In-Hospital Cardiac Arrest

PubMed Central

Khera, Rohan; Chan, Paul S.; Donnino, Michael; Girotra, Saket

2016-01-01

Background For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Methods Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (≥18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge and survival with functional recovery. Results Overall, 13,213 (12.7%) patients had delays to epinephrine, and this rate varied markedly across hospitals (range: 0% to 53.8%). The odds of delay in epinephrine administration were 58% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.58; 95% C.I. 1.51 – 1.64). Median risk-standardized survival rate was 12.0% (range: 5.4% to 31.9%) and risk-standardized survival with functional recovery was 7.4% (range: 0.9% to 30.8%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge (ρ= −0.22, P<0.0001) and survival with functional recovery (ρ= −0.14, P=0.001). Compared to a median survival rate of 12.9% (interquartile range 11.1% to 15.4%) at hospitals in the lowest quartile of epinephrine delay, risk-standardized survival was 16% lower at hospitals in the quartile with the highest rate of epinephrine delays (10.8%, interquartile range: 9.7% to 12.7%). Conclusions Delays in epinephrine administration following in-hospital cardiac arrest are common and varies across hospitals. Hospitals with high rates of delayed epinephrine administration had lower rates of overall survival for in-hospital cardiac arrest due to non-shockable rhythm. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improved outcomes. PMID:27908910

Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest.

PubMed

Khera, Rohan; Chan, Paul S; Donnino, Michael; Girotra, Saket

2016-12-20

For patients with in-hospital cardiac arrests attributable to nonshockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its effect on hospital-level outcomes is unknown. Within Get With The Guidelines-Resuscitation, we identified 103 932 adult patients (≥18 years) at 548 hospitals with an in-hospital cardiac arrest attributable to a nonshockable rhythm who received at least 1 dose of epinephrine between 2000 and 2014. We constructed 2-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge and survival with functional recovery. Overall, 13 213 (12.7%) patients had delays to epinephrine, and this rate varied markedly across hospitals (range, 0%-53.8%). The odds of delay in epinephrine administration were 58% higher at 1 randomly selected hospital in comparison with a similar patient at another randomly selected hospital (median odds ratio, 1.58; 95% confidence interval, 1.51-1.64). The median risk-standardized survival rate was 12.0% (range, 5.4%-31.9%), and the risk-standardized survival with functional recovery was 7.4% (range, 0.9%-30.8%). There was an inverse correlation between a hospital's rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge (ρ=-0.22, P<0.0001) and survival with functional recovery (ρ=-0.14, P=0.001). In comparison with a median survival rate of 12.9% (interquartile range, 11.1%-15.4%) at hospitals in the lowest quartile of epinephrine delay, risk-standardized survival was 16% lower at hospitals in the quartile with the highest rate of epinephrine delays (10.8%; interquartile range, 9.7%-12.7%). Delays in epinephrine administration following in-hospital cardiac arrest are common and variy across hospitals. Hospitals with high rates of delayed epinephrine administration had lower rates of overall survival for in-hospital cardiac arrest attributable to nonshockable rhythm. Further studies are needed to determine whether improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric, will lead to improved outcomes. © 2016 American Heart Association, Inc.

Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial.

PubMed

Karm, Myong-Hwan; Park, Fiona Daye; Kang, Moonkyu; Kim, Hyun Jeong; Kang, Jeong Wan; Kim, Seungoh; Kim, Yong-Deok; Kim, Cheul-Hong; Seo, Kwang-Suk; Kwon, Kyung-Hwan; Kim, Chul-Hwan; Lee, Jung-Woo; Hong, Sung-Woon; Lim, Mi Hyoung; Nam, Seung Kwan; Cho, Jae Min

2017-05-01

The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups. There were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01). The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.

Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars

PubMed Central

Karm, Myong-Hwan; Park, Fiona Daye; Kang, Moonkyu; Kim, Hyun Jeong; Kang, Jeong Wan; Kim, Seungoh; Kim, Yong-Deok; Kim, Cheul-Hong; Seo, Kwang-Suk; Kwon, Kyung-Hwan; Kim, Chul-Hwan; Lee, Jung-Woo; Hong, Sung-Woon; Lim, Mi Hyoung; Nam, Seung Kwan; Cho, Jae Min

2017-01-01

Abstract Background: The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. Methods: Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups. Results: There were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01). Conclusion: The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients. PMID:28538371

Unintentional Epinephrine Auto-injector Injuries: A National Poison Center Observational Study.

PubMed

Anshien, Marco; Rose, S Rutherfoord; Wills, Brandon K

2016-11-24

Epinephrine is the only first-line therapeutic agent used to treat life-threatening anaphylaxis. Epinephrine auto-injectors are commonly carried by patients at risk for anaphylaxis, and reported cases of unintentional auto-injector injury have increased over the last decade. Modifications of existing designs and release of a new style of auto-injector are intended to reduce epinephrine auto-injector misuse. The aim of the study was to characterize reported cases of unintentional epinephrine auto-injector exposures from 2013 to 2014 and compare demographics, auto-injector model, and anatomical site of such exposures. The American Association of Poison Control Center's National Poison Data System was searched from January 1, 2013, to December 31, 2014, for cases of unintentional epinephrine auto-injector exposures. Anatomical site data were obtained from all cases reported to the Virginia Poison Center and participating regional poison center for Auvi-Q cases. A total of 6806 cases of unintentional epinephrine auto-injector exposures were reported to US Poison Centers in 2013 and 2014. Of these cases, 3933 occurred with EpiPen, 2829 with EpiPen Jr, 44 with Auvi-Q, and no case reported of Adrenaclick. The most common site of unintentional injection for traditional epinephrine auto-injectors was the digit or thumb, with 58% of cases for EpiPen and 39% of cases with EpiPen Jr. With Auvi-Q, the most common site was the leg (78% of cases). The number of unintentional epinephrine auto-injector cases reported to American Poison Centers in 2013-2014 has increased compared with previous data. Most EpiPen exposures were in the digits, whereas Auvi-Q was most frequently in the leg. Because of the limitations of Poison Center data, more research is needed to identify incidence of unintentional exposures and the effectiveness of epinephrine auto-injector redesign.

Effects of intraosseous epinephrine in a cardiac arrest swine model.

PubMed

Wong, Marc R; Reggio, Matt J; Morocho, Freddy R; Holloway, Monica M; Garcia-Blanco, Jose C; Jenkins, Constance; Johnson, Arthur D

2016-04-01

Interruptions in cardiopulmonary resuscitation (CPR) to obtain vascular access reduces blood flow to vital organs. Tibial intraosseous (TIO) access may be a faster alternative to intravenous (IV) access for delivery of vasoactive medications. The purpose of this study was to examine the differences in pharmacokinetics and pharmacodynamics of TIO- and IV-delivered epinephrine. A prospective, between subjects, experimental design comparing Cmax, Tmax, return of spontaneous circulation (ROSC), and time to ROSC. Adult male swine were divided into three equal groups (n = 7) all received CPR and defibrillation: the second group received IV epinephrine and the third group received tibial intraosseous epinephrine. Swine were placed in cardiac arrest for 2 min before CPR was initiated. After 2 min of CPR, epinephrine was delivered by IV or TIO, and serial blood samples were collected over 4 min. There were no significant differences between IV versus TIO epinephrine in achieving ROSC, time to ROSC, and Cmax. A one-way analysis of variance demonstrated a significant difference between the IV and TIO groups in Tmax (P = 0.025). A Fisher exact test demonstrated a significant difference between IV epinephrine versus CPR/Defib only (P = 0.035) and TIO epinephrine versus CPR/Defib only (P = 0.010) in achieving ROSC. A multivariate analysis of variance showed significant differences in IV versus intraosseous epinephrine concentration at specific time intervals: 60 (P = 0.023), 90 (P = 0.001), and 120 (P < 0.000) sec. In the context of ROSC, epinephrine delivered via TIO route is a clinically relevant alternative to IV administration. When IV access cannot be immediately obtained in cardiac arrest patients, TIO access should be considered. Published by Elsevier Inc.

Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful?

PubMed Central

Shao, Huan; Li, Chun-Sheng

2017-01-01

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. PMID:28836556

Effect of the addition of vasopressin or vasopressin plus nitroglycerin to epinephrine on arterial blood pressure during cardiopulmonary resuscitation in humans.

PubMed

Ducros, Laurent; Vicaut, Eric; Soleil, Christian; Le Guen, Morgan; Gueye, Papa; Poussant, Thomas; Mebazaa, Alexandre; Payen, Didier; Plaisance, Patrick

2011-11-01

Infusion of a vasopressor during cardiopulmonary resuscitation (CPR) in humans increases end decompression (diastolic) arterial blood pressure, and consequently increases vital organ perfusion pressure and survival. Several vasoactive drugs have been tested alone or in combination, but their hemodynamic effects have not been investigated clinically in humans. We tested the hypothesis that epinephrine (1 mg) co-administered with vasopressin (40 IU) ± nitroglycerin (300 μg) results in higher diastolic blood pressure than epinephrine alone. A prospective, randomized, double-blinded controlled trial in the prehospital setting. The study included 48 patients with witnessed cardiac arrest. Patients received either epinephrine alone (E alone) or epinephrine plus vasopressin (E+V) or epinephrine plus vasopressin plus nitroglycerin (E+V+N). A femoral arterial catheter was inserted for arterial pressure measurement. The primary end point was diastolic blood pressure during CPR, 15 min after the first drug administration (T = 15 min). After exclusions, a total of 44 patients were enrolled. Diastolic blood pressures (mm Hg) at T = 15 min were not statistically different between groups (median [interquartile range]: 20 [10], 15 [6], and 15 [13] for E alone, E+V, and E+V+N, respectively. The rate of return of spontaneous circulation was 63% (n = 10) in the epinephrine group, 43% (n = 6) in the epinephrine plus vasopressin group, and 36% (n = 5) in the triple therapy group (NS). Addition of vasopressin or vasopressin plus nitroglycerin to epinephrine did not increase perfusion blood pressure compared to epinephrine alone in humans in cardiac arrest, suggesting the absence of benefit in using these drug combination(s). Copyright © 2011 Elsevier Inc. All rights reserved.

Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful?

PubMed

Shao, Huan; Li, Chun-Sheng

2017-09-05

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. The EMBASE and PubMed databases were searched with the key words "epinephrine," "cardiac arrest," and variations of these terms. Data from clinical randomized trials, meta-analyses, guidelines, and recent reviews were selected for review. 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. 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.

Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists' perspective.

PubMed

Simons, Elinor; Sicherer, Scott H; Simons, F Estelle R

2012-05-01

The optimal time for transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use from adults to children and teenagers has not yet been defined. To determine whether pediatric allergists have age-specific goals for beginning to transfer responsibilities for anaphylaxis recognition and epinephrine auto-injector use from parents and caregivers to children and teenagers at risk of anaphylaxis in the community. Members of the American Academy of Pediatrics Section on Allergy and Immunology (AAP-SOAI) were surveyed about when they typically begin to transfer these responsibilities from adults to children and teenagers. Eighty-eight allergists responded to the survey, 97.7% of whom provided service to children and teenagers with food allergies. Few allergists expected to begin transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use to children younger than 9 to 11 years. By the time their patients reached age 12 to 14 years, however, most allergists expected them to be able to describe some anaphylaxis symptoms (95.4%), demonstrate how to use an epinephrine auto-injector trainer (93.1%), begin carrying self-injectable epinephrine (88.2%), recognize the need for epinephrine (88.1%), learn to self-inject epinephrine (84.5%), and be able to self-inject epinephrine (78.6%) (cumulative data). The allergists rated the following as "very important" readiness factors for beginning to transfer responsibilities: medical history, developmental level, and ability to demonstrate auto-injector technique. Most pediatric allergists expected that by age 12 to 14 years, their patients should begin to share responsibilities with adults for anaphylaxis recognition and epinephrine auto-injector use; however, they individualized the timing based on assessment of patient readiness factors. Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Use of Epinephrine in Patients with Drug-Induced Anaphylaxis: An Analysis of the Beijing Pharmacovigilance Database

PubMed Central

Wang, Tiansheng; Ma, Xiang; Xing, Yan; Sun, Shusen; Zhang, Hua; Stürmer, Til; Wang, Bin; Li, Xiaotong; Tang, Huilin; Jiao, Ligong; Zhai, Suodi

2017-01-01

Background Few studies assessing the use of epinephrine in drug-induced anaphylaxis (DIA) in the hospital setting are available. We utilized the Beijing Pharmacovigilance Database (BPD) to evaluate the appropriateness of epinephrine for DIA management. Methods DIA cases collected in the BPD from January 2004 to December 2014 were adjudicated and analyzed for demographics, causative drugs, clinical signs, outcomes, initial treatment, route, dosing, and cardiovascular adverse events (CAE) of epinephrine. Results DIA was primarily caused by antibiotics (38.4%), radiocontrast agents (11.9%), traditional Chinese medicine injections (10.9%), and chemotherapeutic drugs (10.3%). Only 708 (59.5%) patients received epinephrine treatment. Patients who received epinephrine were more likely to experience wheezing (p < 0.001) and respiratory arrest (p < 0.001). Among 518 patients with a complete record of the epinephrine administration route, the percentage of patients receiving it by intramuscular (IM) injection, subcutaneous (SC) injection, intravenous (IV) bolus injection, or IV continuous infusion was 16.9, 31.5, 43.5, and 8.1%, respectively. Among the 427 patients with a record of both the administration route and the dosing, an overdose was more likely with IV bolus (94.1%) in contrast to IM injection (56.6%; p < 0.001) or SC injection (43.7%; p < 0.001). Among the patients analyzed for CAE (n = 349), 17 patients accounted for 19 CAE, and 13 (76.5%) of these patients were overdosed with epinephrine. Conclusion Underuse, inappropriate IV bolus use, and overdosing were the 3 major problems with epinephrine use in DIA in China. Educational training for health care professionals on the appropriate use of epinephrine in managing anaphylactic reactions is suggested. PMID:28505618

Epinephrine: The Drug of Choice for Anaphylaxis--A Statement of the World Allergy Organization

PubMed Central

2008-01-01

Anaphylaxis is an acute and potentially lethal multisystem allergic reaction. Most consensus guidelines for the past 30 years have held that epinephrine is the drug of choice and the first drug that should be administered in acute anaphylaxis. Some state that properly administered epinephrine has no absolute contraindication in this clinical setting. A committee of anaphylaxis experts assembled by the World Allergy Organization has examined the evidence from the medical literature concerning the appropriate use of epinephrine for anaphylaxis. The committee strongly believes that epinephrine is currently underused and often dosed suboptimally to treat anaphylaxis, is underprescribed for potential future self-administration, that most of the reasons proposed to withhold its clinical use are flawed, and that the therapeutic benefits of epinephrine exceed the risk when given in appropriate intramuscular doses. PMID:23282530

Chemical and physical compatibility of an intravenous solution of epinephrine with calcium chloride.

PubMed

Weeks, Phillip A; Teng, Yang; Wu, Lei; Sun, Mary; Yang, Zhen; Chow, Diana S-L

2014-01-01

An infusion of epinephrine combined with calcium chloride has been used historically as an intravenous inotropic solution to support critically ill heart failure patients with severe cardiogenic shock. There is no reliable data on the stability of this solution beyond three hours. This study was conducted to evaluate the chemical and physical compatibility of epinephrine (0.032 mg/mL) combined with calcium chloride (4 mg/mL) in a solution for intravenous administration up to 26 hours at room temperature. The chemical stability of epinephrine was monitored by measuring epinephrine concentrations using high-performance liquid chromatography. The physical compatibility of the mixture was determined by measuring spectrophotometric absorbance between 400 to 700 nm. Absorbance greater than 0.010 AU was considered an indicator of the presence of precipitation. The results showed epinephrine with calcium chloride was stable together in normal saline up to 26 hours at room temperature, irrespective of exposure to light. The absorbance of epinephrine throughout the study was less than 0.010 AU, indicating no significant precipitation. Conclusions indicate that epinephrine (0.032 mg/mL) combined with calcium chloride (4 mg/mL) in normal saline at room temperature is acceptably stable up to 26 hours for intravenous administration.

Survey of the use of epinephrine (adrenaline) for anaphylaxis by junior hospital doctors.

PubMed

Jose, Ricardo; Clesham, Gerald J

2007-09-01

Anaphylaxis is a life threatening reaction where prompt and appropriate management can save lives. Epinephrine (adrenaline) is the treatment of choice; however, the recommended dose and route of administration of epinephrine used in the management of anaphylaxis is different from that used in the management of cardiac arrest. To investigate how junior doctors would administer epinephrine in a case of anaphylactic shock in an adult patient. Junior medical staff in two district general hospitals were assessed with a short questionnaire. 95 junior hospital doctors were assessed. The majority (94%) would administer epinephrine as the life saving drug of choice, but only 16.8% would administer it as recommended by the UK Resuscitation Council Guidelines. Junior doctors may be called to make immediate management decisions in patients with anaphylaxis; however, widespread confusion exists regarding the dose and route of administration of epinephrine. Strategies to improve education and access to appropriate drugs are needed. A labelled "anaphylaxis box" on every resuscitation trolley, containing the dose of epinephrine with clear labelling for intramuscular use, may be one solution.

Survey of the use of epinephrine (adrenaline) for anaphylaxis by junior hospital doctors

PubMed Central

Jose, Ricardo; Clesham, Gerald J

2007-01-01

Background Anaphylaxis is a life threatening reaction where prompt and appropriate management can save lives. Epinephrine (adrenaline) is the treatment of choice; however, the recommended dose and route of administration of epinephrine used in the management of anaphylaxis is different from that used in the management of cardiac arrest. Objective To investigate how junior doctors would administer epinephrine in a case of anaphylactic shock in an adult patient. Methods Junior medical staff in two district general hospitals were assessed with a short questionnaire. Results 95 junior hospital doctors were assessed. The majority (94%) would administer epinephrine as the life saving drug of choice, but only 16.8% would administer it as recommended by the UK Resuscitation Council Guidelines. Conclusion Junior doctors may be called to make immediate management decisions in patients with anaphylaxis; however, widespread confusion exists regarding the dose and route of administration of epinephrine. Strategies to improve education and access to appropriate drugs are needed. A labelled “anaphylaxis box” on every resuscitation trolley, containing the dose of epinephrine with clear labelling for intramuscular use, may be one solution. PMID:17823230

Epinephrine Affects Pharmacokinetics of Ropivacaine Infiltrated Into Palate

PubMed Central

Yamashiro, Mikiko; Hashimoto, Shuichi; Yasuda, Asako; Sunada, Katsuhisa

2016-01-01

Pulpal anesthesia success rates for ropivacaine following maxillary infiltration anesthesia seem to be low. We investigated the hypothesis that the addition of epinephrine would affect the pharmacokinetics of ropivacaine by retaining ropivacaine in the mucosa of the injected area through the time-dependent distribution of ropivacaine in the rat maxilla and serum following maxillary infiltration anesthesia using 3H-labeled ropivacaine. We then examined the vasoactivity of ropivacaine with or without epinephrine on local peripheral blood flow. The addition of epinephrine to ropivacaine increased ropivacaine concentrations in the palatal mucosa and adjacent maxilla by more than 3 times that of plain ropivacaine at 20 minutes. By observing the autoradiogram of 3H-ropivacaine, plain ropivacaine in the maxilla was remarkably reduced 20 minutes after injection. However, it was definitely retained in the palatal mucosa, hard palate, adjacent maxilla, and maxillary nerve after the administration with epinephrine. Ropivacaine with epinephrine significantly decreased labial blood flow. This study suggests that 10 μg/mL epinephrine added to 0.5% ropivacaine could improve anesthetic efficacy and duration for maxillary infiltration anesthesia over plain ropivacaine. PMID:27269664

Epinephrine administered with lidocaine solution does not worsen intrathecal lidocaine neurotoxicity in rats.

PubMed

Komatsu, Toshiaki; Takenami, Tamie; Nara, Yoshihiro; Yagishita, Saburo; Kurashige, Chie; Okamoto, Hirotsugu; Yago, Kazuo

2013-01-01

Epinephrine can potentially worsen the neurotoxic effects of local anesthetics when used for spinal or epidural anesthesia. The vasoconstrictive property of epinephrine reduces dural blood flow, which in turn reduces the clearance of local anesthetics from the subarachnoid space. This study examined the histological and neurofunctional effects of intrathecally administered lidocaine combined with epinephrine in rats. Sixty-two rats were divided into 9 treatment groups: 5% or 7.5% lidocaine in 10% glucose solution with or without 0.1 or 0.5 mg/mL epinephrine, or epinephrine alone at 0.1 or 0.5 mg/mL in 10% glucose, or 10% glucose alone. Hind-limb motor function was evaluated immediately after drug injection by walking behavior. Sensory function was assessed by the response to radiant heat stimulation at just before and 1 week after the injection. Seven days after the injection, L3 spinal cord with anterior and posterior roots, the dorsal ganglion, and cauda equina were harvested and examined histologically. Histological lesions were limited to the posterior root just at entry into the spinal cord in rats injected with 7.5% lidocaine, with and without epinephrine. No histological abnormalities were noted in other areas or other groups. There was no significant change in sensory threshold in all groups. Significantly, prolongation of gait recovery time was noted in 5% and 7.5% lidocaine with epinephrine groups compared with 5% or 7.5% lidocaine alone. Intrathecal epinephrine prolonged the action of intrathecal lidocaine but did not worsen lidocaine-induced histological damage and functional impairment.

Treatment with epinephrine (adrenaline) in suspected anaphylaxis during anesthesia in Denmark.

PubMed

Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens; Husum, Bent; Malling, Hans-Jørgen; Mosbech, Holger

2011-07-01

Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min after onset of hypotension as early, and more than 10 min as late, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence. Anaphylaxis should be considered and treated in patients with circulatory instability during anesthesia of no apparent cause who do not respond to the usual treatments.

Hemostatic Agents in Periapical Surgery: A Randomized Study of Gauze Impregnated in Epinephrine versus Aluminum Chloride.

PubMed

Menéndez-Nieto, Isabel; Cervera-Ballester, Juan; Maestre-Ferrín, Laura; Blaya-Tárraga, Juan Antonio; Peñarrocha-Oltra, David; Peñarrocha-Diago, Miguel

2016-11-01

Adequate bleeding control is essential for the success of periapical surgery. The aim of this study was to evaluate the effects of 2 hemostatic agents on the outcome of periapical surgery and their relationship with patient and teeth parameters. A prospective study was designed with 2 randomized parallel groups, depending on the hemostatic agent used: gauze impregnated in epinephrine (epinephrine group) and aluminum chloride (aluminum chloride group). The analysis of the hemorrhage control was judged before and after the application of the hemostatic agents by the surgeon, and 2 examiners independently recorded it as adequate (complete hemorrhage control) or inadequate (incomplete hemorrhage control). Ninety-nine patients with a periradicular lesion were enrolled in this study and divided into 2 groups: gauze impregnated in epinephrine in 48 patients (epinephrine group) or aluminum chloride in 51 (aluminum chloride group). In epinephrine group adequate hemostasis was achieved in 25 cases, and in aluminum chloride group it was achieved in 37 cases (P < .05). The outcome was better in the aluminum chloride group than in the gauze impregnated in epinephrine group. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: A randomized control trial.

PubMed

Johnson, Don; Garcia-Blanco, Jose; Burgert, James; Fulton, Lawrence; Kadilak, Patrick; Perry, Katherine; Burke, Jeffrey

2015-09-01

Cardiopulmonary Resuscitation (CPR), defibrillation, and epinephrine administration are pillars of advanced cardiac life support (ACLS). Intraosseous (IO) access is an alternative route for epinephrine administration when intravenous (IV) access is unobtainable. Previous studies indicate the pharmacokinetics of epinephrine administration via IO and IV routes differ, but it is not known if the difference influences return of spontaneous circulation (ROSC). The purpose of this prospective, experimental study was to determine the effects of humeral IO (HIO) and IV epinephrine administration during cardiac arrest on pharmacokinetics, ROSC, and odds of survival. Swine (N = 21) were randomized into 3 groups: humeral IO (HIO), peripheral IV (IV) and CPR/defibrillation control. Cardiac arrest was induced under general anesthesia. The swine remained in arrest for 2 min without intervention. Chest compressions were initiated and continued for 2 min. Epinephrine was administered and serial blood samples collected for pharmacokinetic analysis over 4 min. Defibrillation and epinephrine administration proceeded according to ACLS guidelines continuing for 20 min or until ROSC. Seven HIO swine, 4 IV swine, and no control swine had ROSC. There were no significant differences in ROSC, maximum concentration; except at 30 s, and time-to-concentration-maximum between the HIO and IV groups. Significant differences existed between the experimental groups and the control. The HIO delivers a higher concentration of epinephrine than the IV route at 30 s which may be a survival advantage. Clinicians may consider using the IO route to administer epinephrine during CA when there is no preexisting IV access or when IV access is unobtainable.

Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: A randomized control trial

PubMed Central

Johnson, Don; Garcia-Blanco, Jose; Burgert, James; Fulton, Lawrence; Kadilak, Patrick; Perry, Katherine; Burke, Jeffrey

2015-01-01

Cardiopulmonary Resuscitation (CPR), defibrillation, and epinephrine administration are pillars of advanced cardiac life support (ACLS). Intraosseous (IO) access is an alternative route for epinephrine administration when intravenous (IV) access is unobtainable. Previous studies indicate the pharmacokinetics of epinephrine administration via IO and IV routes differ, but it is not known if the difference influences return of spontaneous circulation (ROSC). The purpose of this prospective, experimental study was to determine the effects of humeral IO (HIO) and IV epinephrine administration during cardiac arrest on pharmacokinetics, ROSC, and odds of survival. Swine (N = 21) were randomized into 3 groups: humeral IO (HIO), peripheral IV (IV) and CPR/defibrillation control. Cardiac arrest was induced under general anesthesia. The swine remained in arrest for 2 min without intervention. Chest compressions were initiated and continued for 2 min. Epinephrine was administered and serial blood samples collected for pharmacokinetic analysis over 4 min. Defibrillation and epinephrine administration proceeded according to ACLS guidelines continuing for 20 min or until ROSC. Seven HIO swine, 4 IV swine, and no control swine had ROSC. There were no significant differences in ROSC, maximum concentration; except at 30 s, and time-to-concentration-maximum between the HIO and IV groups. Significant differences existed between the experimental groups and the control. The HIO delivers a higher concentration of epinephrine than the IV route at 30 s which may be a survival advantage. Clinicians may consider using the IO route to administer epinephrine during CA when there is no preexisting IV access or when IV access is unobtainable. PMID:26468375

Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest.

PubMed

Lin, Yan-Ren; Syue, Yuan-Jhen; Buddhakosai, Waradee; Lu, Huai-En; Chang, Chin-Fu; Chang, Chih-Yu; Chen, Cheng Hsu; Chen, Wen-Liang; Li, Chao-Jui

2016-03-01

The postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest (OHCA) might be impacted by the early administration of epinephrine, but this topic has not been well addressed. The aim of this study was to analyze the early postresuscitative hemodynamics, survival, and neurologic outcome according to different time points of first epinephrine treatment among children with traumatic OHCA.Information on 388 children who presented to the emergency departments of 3 medical centers and who were treated with epinephrine for traumatic OHCA during the study period (2003-2012) was retrospectively collected. The early postresuscitative hemodynamic features (cardiac functions, end-organ perfusion, and consciousness), survival, and neurologic outcome according to different time points of first epinephrine treatment (early: <15, intermediate: 15-30, and late: >30 minutes after collapse) were analyzed.Among 165 children who achieved sustained return of spontaneous circulation, 38 children (9.8%) survived to discharge and 12 children (3.1%) had good neurologic outcomes. Early epinephrine increased the postresuscitative heart rate and blood pressure in the first 30 minutes, but ultimately impaired end-organ perfusion (decreased urine output and initial creatinine clearance) (all P < 0.05). Early epinephrine treatment increased the chance of achieving sustained return of spontaneous circulation, but did not increase the rates of survival and good neurologic outcome.Early epinephrine temporarily increased heart rate and blood pressure in the first 30 minutes of the postresuscitative period, but impaired end-organ perfusion. Most importantly, the rates of survival and good neurologic outcome were not significantly increased by early epinephrine administration.

Effect of exercise on epinephrine turnover in trained and untrained male subjects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kjaer, M.; Christensen, N.J.; Sonne, B.

The kinetics underlying plasma epinephrine concentrations were studied. Six athletes (T) and six sedentary males (C) were given intravenous infusions of TH-labeled epinephrine, after which arterial blood was drawn. They rested sitting and bicycled continuously to exhaustion (60 min at 125 W, 60 min at 160 W, 40 min at 200 W, and 240 W to the end). Work time was 154 +/- 13 (SE) (T) and 75 +/- 6 (C) min. At rest, epinephrine clearance was identical (28.4 +/- 1.3 (T) vs. 29.2 +/- 1.8 (C) ml . kg-1 . min-1), but plasma concentration (1.42 +/- 0.27 (T) vs.more » 0.71 +/- 0.16 (C) nmol . l-1) and, accordingly, secretion (2.9 +/- 0.7 vs. 1.5 +/- 0.4 nmol . min-1) were higher (P less than 0.05) in T than C subjects. Epinephrine clearance was closely related to relative work load, decreasing from 15% above the basal level at 30% of maximal O2 uptake (VO2 max) to 22% below at 76% of VO2 max. Epinephrine concentrations increased much more with work intensity than could be accounted for by changes in clearance and were, at exhaustion, higher (P less than 0.05) in T (7.2 +/- 1.6) than in C (2.5 +/- 0.7 nmol . l-1) subjects despite similar glucose, heart rate, and hematocrit values. At a given load, epinephrine clearance rapidly became constant, whereas concentration increased continuously. Forearm extraction of epinephrine invalidated use of blood from a cubital vein or a hand vein arterialized by hot water in turnover measurements. During exercise, changes in epinephrine concentrations reflect changes in secretion rather than in clearance. Training may increase adrenal medullary secretory capacity.« less

Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

PubMed Central

Ljubicic, Neven; Budimir, Ivan; Biscanin, Alen; Nikolic, Marko; Supanc, Vladimir; Hrabar, Davor; Pavic, Tajana

2012-01-01

AIM: To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer. METHODS: Between January 2005 and December 2009, 150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed (Forrest IIa) were included in the study. Patients were randomized to receive a small-volume epinephrine group (15 to 25 mL injection group; Group 1, n = 50), a large-volume epinephrine group (30 to 40 mL injection group; Group 2, n = 50) and a hemoclip group (Group 3, n = 50). The rate of recurrent bleeding, as the primary outcome, was compared between the groups of patients included in the study. Secondary outcomes compared between the groups were primary hemostasis rate, permanent hemostasis, need for emergency surgery, 30 d mortality, bleeding-related deaths, length of hospital stay and transfusion requirements. RESULTS: Initial hemostasis was obtained in all patients. The rate of early recurrent bleeding was 30% (15/50) in the small-volume epinephrine group (Group 1) and 16% (8/50) in the large-volume epinephrine group (Group 2) (P = 0.09). The rate of recurrent bleeding was 4% (2/50) in the hemoclip group (Group 3); the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution (P = 0.0005 and P = 0.045, respectively). Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups. CONCLUSION: Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer. PMID:22611315

Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest

PubMed Central

Lin, Yan-Ren; Syue, Yuan-Jhen; Buddhakosai, Waradee; Lu, Huai-En; Chang, Chin-Fu; Chang, Chih-Yu; Chen, Cheng Hsu; Chen, Wen-Liang; Li, Chao-Jui

2016-01-01

Abstract The postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest (OHCA) might be impacted by the early administration of epinephrine, but this topic has not been well addressed. The aim of this study was to analyze the early postresuscitative hemodynamics, survival, and neurologic outcome according to different time points of first epinephrine treatment among children with traumatic OHCA. Information on 388 children who presented to the emergency departments of 3 medical centers and who were treated with epinephrine for traumatic OHCA during the study period (2003–2012) was retrospectively collected. The early postresuscitative hemodynamic features (cardiac functions, end-organ perfusion, and consciousness), survival, and neurologic outcome according to different time points of first epinephrine treatment (early: <15, intermediate: 15–30, and late: >30 minutes after collapse) were analyzed. Among 165 children who achieved sustained return of spontaneous circulation, 38 children (9.8%) survived to discharge and 12 children (3.1%) had good neurologic outcomes. Early epinephrine increased the postresuscitative heart rate and blood pressure in the first 30 minutes, but ultimately impaired end-organ perfusion (decreased urine output and initial creatinine clearance) (all P < 0.05). Early epinephrine treatment increased the chance of achieving sustained return of spontaneous circulation, but did not increase the rates of survival and good neurologic outcome. Early epinephrine temporarily increased heart rate and blood pressure in the first 30 minutes of the postresuscitative period, but impaired end-organ perfusion. Most importantly, the rates of survival and good neurologic outcome were not significantly increased by early epinephrine administration. PMID:27015217

The Pathophysiology of Early Hypotension Following Epinephrine-containing Local Anesthetic Infiltration of the Nasal Mucosa in Patients Undergoing Endoscopic Transsphenoidal Hypophysectomy: A Prospective, Observational Study.

PubMed

Wiles, Matthew D; Sanders, Matthew I; Sinha, Saurabh; Mirza, Showkat; Andrzejowski, John C

2017-07-01

In patients undergoing endoscopic transsphenoidal hypophysectomy, the nasal mucosa is often infiltrated with local anesthetic solutions that contain epinephrine to aid hemostasis. This may, however, result in hemodynamic changes, especially hypotension. We characterized the cardiovascular changes using a LiDCOrapid monitor in 13 patients after the infiltration of 4% articaine containing 1:200,000 epinephrine. Nine (69%) had a >20% decrease in mean arterial pressure at a median time of 116 seconds after the infiltration of articaine with epinephrine. Analysis of the cardiac output data revealed that this was caused by a sustained reduction in systemic vascular resistance. The arterial blood pressure normalized over a period of 60 to 90 seconds secondary to increases in stroke volume and heart rate producing an elevation in cardiac output. Transient hypotension following the infiltration of epinephrine-containing local anesthetics may be caused by epinephrine stimulation of β2-adrenoceptors producing vasodilation.

Naloxone and epinephrine are equally effective for cardiopulmonary resuscitation in a rat asphyxia model.

PubMed

Chen, M-H; Xie, L; Liu, T-W; Song, F-Q; He, T

2006-10-01

It is not known whether naloxone is as efficacious as epinephrine during cardiopulmonary resuscitation (CPR). The aim of the study was to compare the effects of naloxone and epinephrine on the outcomes of CPR following asphyxial cardiac arrest in rats. Cardiac arrest was induced with asphyxia by clamping the tracheal tubes. Twenty-four Sprague-Dawley rats were randomized prospectively into a saline group (treated with normal saline, 1 ml intravenously, n = 8), an epinephrine group (treated with epinephrine, 0.04 mg/kg intravenously, n = 8) or a naloxone group (treated with naloxone, 1 mg/kg intravenously, n = 8) in a blind fashion during resuscitation after asphyxial cardiac arrest. After 5 min of untreated cardiac arrest, conventional manual CPR was started and each drug was administered at the same time. The rates of restoration of spontaneous circulation (ROSC) were one of eight (12.5%), seven of eight (87.5%) and seven of eight (87.5%) in the saline, epinephrine and naloxone groups, respectively. The rates of ROSC in the epinephrine and naloxone groups were equal and significantly greater than that in the saline group (P = 0.01 and P = 0.01, respectively). The administration of naloxone or epinephrine alone may increase the resuscitation rate, and both drugs are equally effective for CPR in a rat asphyxia model. However, the mechanism by which naloxone produces its efficacy during CPR remains unclear and further experimentation will be necessary.

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis

PubMed Central

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton

2016-01-01

Objectives To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Design Prospective observational cohort study. Setting Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Participants Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Intervention Epinephrine given within two minutes after the first defibrillation. Main outcome measures Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were “at risk” of receiving epinephrine within the same minute but who did not receive it. Results 2978patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation (0.71, 0.60 to 0.83; P<0.001) and good functional outcome (0.69, 0.58 to 0.83; P<0.001). Conclusion Half of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines. The receipt of epinephrine within two minutes after the first defibrillation was associated with decreased odds of survival to hospital discharge as well as decreased odds of return of spontaneous circulation and survival to hospital discharge with a good functional outcome. PMID:27053638

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.

PubMed

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton; Donnino, Michael W

2016-04-06

To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Prospective observational cohort study. Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Epinephrine given within two minutes after the first defibrillation. Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation (0.71, 0.60 to 0.83; P<0.001) and good functional outcome (0.69, 0.58 to 0.83; P<0.001). Half of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines. The receipt of epinephrine within two minutes after the first defibrillation was associated with decreased odds of survival to hospital discharge as well as decreased odds of return of spontaneous circulation and survival to hospital discharge with a good functional outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Clinical and physiological rationale for use of clonidine with articaine and adrenaline for local anesthesia in pediatric dentistry].

PubMed

Mel'nikova, A V; Shugaĭlov, I A

2014-01-01

The study evaluated the effect of local anesthesia with articaine in different combinations with epinephrine and clonidine (articaine (4%) + epinephrine (1:200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1:400 000) + clonidine (1:100 000)), on a number of physiological parameters in pediatric dental practice that characterize cardiovascular system, patient's degree of adaptation to a stressful situation and efficacy of analgesia. It is shown that in terms of impact on the cardiovascular system and stress adaptation indicators anesthesia including combination of epinephrine (1: 200 000) and clonidine (1: 100 000) in the anesthetic solution is the safest. Furthermore, this method ensures the most appropriate analgesic effect.

Excess intake of fat and sugar potentiates epinephrine-induced hyperglycemia in male rats.

PubMed

Ross, Amy P; Darling, Jenna N; Parent, Marise B

2015-04-01

Over the past five decades, per capita caloric intake has increased significantly, and diet- and stress-related diseases are more prevalent. The stress hormone epinephrine stimulates hepatic glucose release during a stress response. The present experiment tested the hypothesis that excess caloric intake alters this ability of epinephrine to increase blood glucose. Sprague-Dawley rats were fed a high-energy cafeteria-style diet (HED). Weight gain during the first 5 days on the diet was used to divide the rats into an HED-lean group and HED-obese group. After 9 weeks, the rats were injected with epinephrine, and blood glucose was measured. HED-obese rats gained body and fat mass, and developed insulin resistance (IR) and hepatic steatosis. HED-lean and control rats did not differ. Epinephrine produced larger increases in blood glucose in the HED-obese rats than in the HED-lean and control rats. Removing the high-energy components of the diet for 4 weeks reversed the potentiated effects of epinephrine on glucose and corrected the IR but not the steatosis or obesity. Consumption of a high-energy cafeteria diet potentiates epinephrine-induced hyperglycemia. This effect is associated with insulin resistance but not adiposity or steatosis and is reversed by 4 weeks of standard chow. Copyright © 2015 Elsevier Inc. All rights reserved.

Epinephrine Use in Clinical Trials of Sublingual Immunotherapy Tablets.

PubMed

Nolte, Hendrik; Casale, Thomas B; Lockey, Richard F; Fogh, Bodil Svanholm; Kaur, Amarjot; Lu, Susan; Nelson, Harold S

Allergy immunotherapy can result in systemic allergic reactions and even life-threatening anaphylaxis requiring epinephrine administration. The objective of this study was to describe epinephrine use in the clinical trial development programs of 3 rapidly dissolving sublingual immunotherapy tablets (SLIT-tablets; Merck & Co., Inc., Kenilworth, NJ/ALK, Hørsholm, Denmark/Torii Pharmaceutical Co., Ltd., Tokyo, Japan). Data on epinephrine use were collected from 13 timothy grass SLIT-tablet trials (MK-7243; ≤2800 bioequivalent allergen units/75,000 SQ-T dose, n = 2497; placebo, n = 2139), 5 short ragweed SLIT-tablet trials (MK-3641; ≤12 Amb a 1-U, n = 1725; placebo, n = 770), and 11 house dust mite (HDM) SLIT-tablet trials (MK-8237; ≤12 SQ-HDM; n = 3930; placebo, n = 2246). In grass SLIT-tablet trials, epinephrine was used 13 times (grass SLIT-tablet, n = 10; placebo, n = 3). Eight administrations were for grass SLIT-tablet-related adverse events (AEs): 4 for systemic allergic reactions and 4 for local mouth and/or throat swelling. In ragweed SLIT-tablet trials, epinephrine was used 9 times in 8 subjects (ragweed SLIT-tablet, n = 7; placebo, n = 1 [2 administrations for protracted anaphylaxis]). Four administrations were for ragweed SLIT-tablet-related AEs: 1 for systemic allergic reaction and 3 for local mouth and/or pharynx/throat swelling. In HDM SLIT-tablet trials, epinephrine was administered 13 times (HDM SLIT-tablet, n = 8; placebo, n = 5). Four administrations were for HDM SLIT-tablet-related AEs: 1 for systemic allergic reaction and 3 for local events. Of the 16 epinephrine administrations for events related to SLIT-tablet treatment, 11 occurred within the first week of treatment (7 administrations on day 1) and 5 were subject self-administered. Epinephrine administrations in response to SLIT-tablet-related reactions in clinical trials are uncommon, typically occur within the first week of treatment, and are rarely self-administered. All SLIT-tablet-related events treated with epinephrine were nonserious. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Epinephrine doses delivered from auto-injectors stored at excessively high temperatures.

PubMed

Rachid, Ousama; Simons, F Estelle R; Rawas-Qalaji, Mutasem; Lewis, Stephen; Simons, Keith J

2016-01-01

Prompt injection of epinephrine (adrenaline) from epinephrine auto-injectors (EAIs) is the primary treatment for anaphylaxis in out-of-hospital settings. Storage of EAIs at room temperature (25 °C) is advised; however, storage at excessively high temperatures sometimes occurs. To our knowledge, there are no previous publications on the doses of epinephrine ejected from EAIs after storage at such temperatures. We examined the epinephrine doses delivered from activated EAIs stored constantly or cyclically at 70 °C. Twenty-five in-date EAIs were stored constantly or cyclically at 70 °C (excessive heat) or 25 °C (controls) for 5 d or 10 d. EAIs were activated and the epinephrine doses in the ejected solutions were measured using HPLC-UV. The enantiomeric purity of epinephrine was also measured by HPLC-UV. Control EAIs ejected a volume of 0.300 ± 0.006 mL containing 103.7 ± 3.3% of labeled dose (LD). After 5 d or 10 d of constant storage at 70 °C and activation at 70 °C, EAIs ejected a volume of 0.367 ± 0.008 mL containing 96.8 ± 3.8% LD and 0.373 ± 0.007 mL containing 77.7 ± 3.3% LD, respectively. After 5 d of cyclic storage at 70 °C and cooling to 25 °C before activation, EAIs ejected a volume of 0.311 ± 0.008 mL containing 87.2 ± 1.9% LD. Under the experimental conditions of this study, the resultant chromatographic peaks of epinephrine solutions from all EAIs represented only the pure l-enantiomer of epinephrine. EAIs should be stored under recommended conditions of the manufacturer. EAIs stored at excessively high temperatures cannot be used to treat humans while still hot, and when cooled, cannot be relied on to deliver the labeled epinephrine dose in anaphylaxis.

Evaluating real-time effects of topical 1:1000 epinephrine in endoscopic sinus and skull-base surgery on hemodynamic parameters through intraoperative arterial line monitoring.

PubMed

Yim, Michael T; Ahmed, Omar G; Takashima, Masayoshi

2017-11-01

Administration of topical 1:1000 epinephrine is commonly used in practice to achieve vasoconstriction during endoscopic sinus surgery and skull-base surgery; however, real-time effects on cardiovascular changes from systemic absorption have not been well studied. Twenty-six patients undergoing endoscopic transsphenoidal resection of a pituitary lesion at a single institution were included into the study. Following arterial line placement by anesthesiology, 6 cottonoid pledgets soaked in 1:1000 epinephrine were placed into the bilateral nasal passages. Hemodynamic parameters including heart rate, blood pressure, and mean arterial pressure were collected at baseline, 30 seconds, and increments in minutes up to 10 minutes. Additional potentially confounding factors such as use of antihypertensives, stress dose steroids, and positioning with head pins were all performed following termination of data collection. The majority of patients (20/26, 77%) showed no significant change in any parameter following placement of epinephrine soaked cottonoids. Six patients, however, had transient increases in blood pressure following administration of topical epinephrine, with a few requiring vasodilatory interventions. Return to baseline cardiovascular values were noted after an average of 7 minutes. There was no correlative preoperative characteristic that predicted sensitivity to placement of epinephrine. There were no lasting or permanent effects. Although intranasal topical 1:1000 epinephrine use showed no substantial hemodynamic changes in the majority of patients, in a subset of patients it can cause significant transient elevations in blood pressure to a degree necessitating intervention. Topical epinephrine should be used judiciously in endoscopic sinus surgery. © 2017 ARS-AAOA, LLC.

Epinephrine and left atrial and left ventricular diastolic function decrease in normal subjects.

PubMed

Fuenmayor, Abdel J; Solórzano, Moisés I; Gómez, Luisangelly

2016-10-01

We assessed the effect of epinephrine over left atrial and left ventricular diastolic function in subjects without structural heart disease. Twenty-seven, 34.6±17.2year-old patients without structural heart disease were included. Intravenous epinephrine (50 to 100ng/kg/min) was infused. Left atrial and ventricular functions were evaluated by means of echocardiography before and during the epinephrine infusion. No complications were observed. Significant increases in heart rate and systolic blood pressure were recorded. Both left atrial (minimal and maximal) volumes increased but increase in the minimal volume was more pronounced, and the ejection fraction diminished. Left atrial expansion index decreased and the fraction of left ventricular inflow volume resulting from atrial contraction increased. Two patients displayed abnormal left ventricular diastolic function. During epinephrine infusion, E/A and e' decreased, and isovolumetric relaxation time increased. In this group of young adults without structural heart disease, epinephrine infusion was safe, did not produce any complications, and induced a small but significant decrease in left atrial function and left ventricular diastolic function. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Technical note: Effects of an epinephrine infusion on eye temperature and heart rate variability in bull calves.

PubMed

Stewart, M; Webster, J R; Stafford, K J; Schaefer, A L; Verkerk, G A

2010-11-01

Changes in autonomic nervous system (ANS) activity are one of the first phases of a stress response, but they are rarely used to assess the welfare of farm animals. Eye temperature measured using infrared thermography (IRT) is proposed as an indicator of ANS activity because it may reflect changes in blood flow in the capillary beds of the conjunctiva. The aim was to determine whether epinephrine infusion would initiate eye temperature changes in calves. Sixteen 4-mo-old Friesian calves (124±5 kg) were assigned randomly to receive a jugular infusion of either epinephrine (4 μg/kg per min for 5 min) or saline. Eye temperature (°C), heart rate (HR), and HR variability (HRV) were recorded from 15 min before infusion until 10 min after it was completed. Blood samples collected via jugular catheter were assayed for epinephrine, norepinephrine, and cortisol concentrations, and packed cell volume (PCV) was measured. No changes in any variable were observed with the saline infusion. Plasma epinephrine concentrations increased 90-fold with epinephrine infusion, which was associated with a decrease in eye temperature of 1.4±0.05°C. During epinephrine infusion, plasma norepinephrine concentrations decreased by half and HR decreased by 9.3±3.3 beats/min. The HRV measure, the root mean square of successive differences, increased by 49.7±9.2 ms, indicating a compensatory increase in parasympathetic activity. After epinephrine infusion, plasma cortisol concentrations increased by 10.4±1.7 ng/mL and PCV was higher (38 vs. 31±0.1%, epinephrine vs. saline, respectively). These results support the hypothesis that changes in eye temperature are mediated by the sympathetic component of the ANS. Infrared thermography is a noninvasive method to assess ANS activity for evaluating welfare of cattle. Copyright © 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Does the combination of 3% mepivacaine plain plus 2% lidocaine with epinephrine improve anesthesia and reduce the pain of anesthetic injection for the inferior alveolar nerve block? A prospective, randomized, double-blind study.

PubMed

Lammers, Emily; Nusstein, John; Reader, Al; Drum, Melissa; Beck, Mike; Fowler, Sara

2014-09-01

In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the pain of injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection pain was also studied. One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the pain of injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes. Success was not significantly different (P > .05) between the 2 combinations. No statistical differences in injection pain or onset times were found. The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of injection pain, onset time, and pulpal anesthetic success for the IAN block. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Topical concentrated epinephrine (1:1000) does not cause acute cardiovascular changes during endoscopic sinus surgery.

PubMed

Gunaratne, Dakshika A; Barham, Henry P; Christensen, Jenna M; Bhatia, Daman D S; Stamm, Aldo C; Harvey, Richard J

2016-02-01

Topical epinephrine is used in endoscopic sinonasal surgery for local vasoconstriction. Potential for cardiovascular complications remains a concern for some due to the possibility of systemic absorption. Topical vs injected epinephrine was examined in a prospective analysis of perioperative cardiovascular effects, and in an audit of cardiovascular complications during endoscopic sinonasal surgery. A prospective cohort study of patients undergoing endoscopic sinonasal surgery was performed. Topical (1:1000) and injected (1:100,000) epinephrine were assessed. Cardiovascular outcomes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and electrocardiogram (ECG) changes were examined at baseline and minutely post-topical application (to 10 minutes) and postinjection (to 5 minutes). A retrospective assessment of cardiovascular events associated with a standardized regimen of topical (1:2000) and injected (1:100,000) epinephrine was performed. Nineteen patents were assessed (43.42 ± 15.90 years, 47.4% female) in the prospective analysis. Post-topical epinephrine, no significant changes occurred in any cardiovascular parameter. However, following injected epinephrine, changes in HR (59.53 vs 64.11 bpm, p < 0.001), SBP (96.16 vs 102.95 mmHg, p = 0.015), DBP (56.53 vs 60.74 mmHg, p = 0.019), and MAP (69.74 vs 74.81 mmHg, p = 0.002) occurred. On repeated-measures analysis of variance (ANOVA) all parameters were significantly affected by injection. No ECG abnormalities were seen in either topical or injection phases. The retrospective analysis of 1260 cases identified 2 cases of cardiovascular complications (0.16%), both relating to injected epinephrine. Combination topical (1:1000 to 1:2000) and injectable (1:100,000) epinephrine is safe for use in endoscopic sinonasal surgery. Injection resulted in the cardiovascular changes and accounted for the cardiovascular events reported. © 2015 ARS-AAOA, LLC.

THE INFLUENCE OF CERTAIN FACTORS, ESPECIALLY EMOTIONAL DISTURBANCES, ON THE EPINEPHRIN CONTENT OF THE ADRENALS

PubMed Central

Stewart, G. N.; Rogoff, J. M.

1916-01-01

1. No evidence has been obtained that in cats and dogs with the nerves of one adrenal cut, emotional disturbances cause depletion of the epinephrin store of the normally innervated adrenal as compared with its fellow. 2. The depletion of the epinephrin store in cats under morphine is not dependent upon so called morphine fright, since a similar depletion is found in dogs in which, as is known, morphine produces symptoms the reverse of those of fright. 3. The signs of morphine fright can all be elicited by administering morphine to a cat in which one adrenal has been removed and the nerve supply of the other cut, and in which accordingly no detectable liberation of epinephrin takes place. 4. The reactions of the denervated iris elicited by emotional disturbance, asphyxia, or etherization in a cat, one of whose adrenals has been removed and the nerves of the other cut, do not differ from these reactions in cats whose adrenals have not been interfered with. 5. The influence of postoperative edema of the adrenal in diminishing the epinephrin load, and the recuperation of the load after a time, have been studied in rabbits. 6. The diminution in the epinephrin store of the adrenals which follows operations on animals (postoperative depletion) has been studied. It is only in part associated with the anesthesia, since it may be as marked 6 or 8 hours after an operation lasting less than 1 hour as after 6 or 8 hours' anesthesia without operation. 7. One adrenal was removed in rabbits and the epinephrin content of the remaining gland assayed at varying periods of time after removal of the first, the periods being longer than the time necessary for recovery from the postoperative depletion. In general, the second adrenal contained more epinephrin than the first, sometimes double the amount. 8. Marked depletion of the epinephrin store of innervated adrenals as compared with the corresponding denervated glands was seen in animals dead of infections of various kinds. 9. As shown by Elliott, diminution of the stock of epinephrin in the adrenal through electrical stimulation of the splanchnics is not easy to demonstrate, despite the fact that the liberation of epinephrin into the blood is notably increased by the stimulation. With short periods of stimulation, however, repeated over a long time at intervals just long enough to prevent fatigue, it has proved possible to demonstrate a distinct depletion. PMID:19868069

Comparative investigations on the efficacy of articaine 4% (epinephrine 1:200,000) and articaine 2% (epinephrine 1:200,000) in local infiltration anaesthesia in dentistry--a randomised double-blind study.

PubMed

Hintze, A; Paessler, L

2006-06-01

A randomised double-blind study investigated 155 patients with tooth extractions in the mandibular and maxillary jaws for a loss of anaesthetic potency when reducing the concentration of the active in articaine solutions. Tests were performed on the preparations of articaine 4% with a 1:200,000 addition of epinephrine (Ultracain D-S) and articaine 2% with a 1:200,000 addition of epinephrine (Ultracain 2%-Suprarenin). Local infiltration anaesthesia was the chosen method of anaesthesia. The most noticeable difference observed between the two injection solutions concerned the duration of anaesthesia, which was significantly shortened under the low-dose solution. The 4% articaine solution did not prove superior in local anaesthetic effect. Articaine 2% with epinephrine 1:200,000, therefore, can be considered a suitable local anaesthetic for tooth extractions.

Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.

PubMed

Kiss, Gabor; Corre, Olivier; Gueret, Gildas; Nguyen Ba, Vinh; Gilard, Martine; Boschat, Jaques; Arvieux, Charles Chistian

2009-01-01

Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness. Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.

Circulating catecholamine and glucose concentrations in Japanese toads (Bufo japonicus) during the breeding season.

PubMed

Wilson, J X; Sawai, H; Kikuchi, M; Kubokawa, K; Ishii, S

1995-06-01

We investigated the relationship between catecholamine neurohormones and glucose during seasonal reproductive activity in Japanese toads (Bufo japonicus). Field studies found that plasma epinephrine concentration increased as toads migrated to their breeding ponds, where amplexus most frequently took place. Blood glucose concentration also increased as toads arrived at the ponds, even though these animals did not eat during the breeding season, and there was a positive correlation between epinephrine and glucose levels. Blood glucose concentration was higher in amplectic than in solitary males, whereas this relationship did not occur in females. For both males and females, plasma epinephrine concentration was elevated during amplexus. The plasma concentration of norepinephrine was lower than that of epinephrine and did not correlate with either the proximity of the animal to the breeding ponds or the blood glucose concentration. Laboratory experiments showed that systemic injection of [Trp7,Leu8]gonadotropin-releasing hormone (sGnRH) increased plasma epinephrine to levels characteristic of amplectic feral toads. These results suggest that a physiological role of GnRH-like peptides may be to stimulate epinephrine secretion and consequently to increase glucose production in toads under the starvation conditions associated with the breeding migration.

The induction of thioredoxin-1 by epinephrine withdraws stress via interaction with β-arrestin-1

PubMed Central

Jia, Jin-Jing; Zeng, Xian-Si; Zhou, Xiao-Shuang; Li, Ye; Bai, Jie

2014-01-01

Stress regulates a panel of important physiological functions and disease states. Epinephrine is produced under stresses threaten to homeostasis. Thioredoxin-1(Trx-1) is a redox regulating protein which is induced to resist stresses and related with various diseases. Thus, it is important to examine whether Trx-1 is induced by epinephrine and to understand the underlying molecular mechanisms that Trx-1 modulates epinephrine stress. Here, we show that the expression of Trx-1 was induced by epinephrine via β-adrenergic receptor/Cyclic AMP/protein kinase A (PKA) signaling pathway in PC12 cells. The down-regulation of Trx-1 by siRNA aggravated accumulation of γ-H2AX and further decreased expression of p53 by epinephrine. Accordingly, Trx-1 overexpression alleviated accumulation of γ-H2AX and restored the expressions of p53 and C/EBP homologous protein (CHOP) in the cortex, hippocampus and thymus of mice. Moreover, Trx-1 overexpression reduced the malondialdehyde concentration by epinephrine. We further explored the mechanism on p53 and γ-H2AX regulated by Trx-1. We found that overexpression of Trx-1 suppressed β-arrestin-1 expression through interaction with β-arrestin-1. Consequently, the downregulation of β-arrestin-1 suppressed the cell viability and the expressions of γ-H2AX and cyclin D1, and increased p53 expression. Taken together, our data suggest that Trx-1/β-arrestin-1 interaction may represent a novel endogenous mechanism on protecting against stress. PMID:25486571

Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

PubMed Central

Berde, Charles B.; Athiraman, Umeshkumar; Yahalom, Barak; Zurakowski, David; Corfas, Gabriel; Bognet, Christina

2011-01-01

Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX) with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL) solutions, with or without epinephrine 5 µg/mL (1:200,000) in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001) or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001). Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia. PMID:22363247

Tetrodotoxin-bupivacaine-epinephrine combinations for prolonged local anesthesia.

PubMed

Berde, Charles B; Athiraman, Umeshkumar; Yahalom, Barak; Zurakowski, David; Corfas, Gabriel; Bognet, Christina

2011-12-01

Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX) with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL) solutions, with or without epinephrine 5 µg/mL (1:200,000) in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001) or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001). Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

Recruitment of GABA(A) receptors and fearfulness in chicks: modulation by systemic insulin and/or epinephrine.

PubMed

Cid, Mariana Paula; Toledo, Carolina Maribel; Salvatierra, Nancy Alicia

2013-02-01

One-day-old chicks were individually assessed on their latency to peck pebbles, and categorized as low latency (LL) or high latency (HL) according to fear. Interactions between acute stress and systemic insulin and epinephrine on GABA(A) receptor density in the forebrain were studied. At 10 days of life, LL and HL chicks were intraperitoneally injected with insulin, epinephrine or saline, and immediately after stressed by partial water immersion for 15 min and killed by decapitation. Forebrains were dissected and the GABA(A) receptor density was measured ex vivo by the (3)[H]-flunitrazepam binding assay in synaptosomes. In non-stressed chicks, insulin (non-hypoglycemic dose) at 2.50 IU/kg of body weight incremented the Bmax by 40.53% in the HL chicks compared to saline group whereas no significant differences were observed between individuals in the LL subpopulation. Additionally, insulin increased the Bmax (23.48%) in the HL group with respect to the LL ones, indicating that the insulin responses were different according to the anxiety of each category. Epinephrine administration (0.25 and 0.50mg/kg) incremented the Bmax in non-stressed chicks, in the LL group by about 37% and 33%, respectively, compared to ones injected with saline. In the stressed chicks, 0.25mg/kg bw epinephrine increased the Bmax significantly in the HL group by about 24% compared to saline, suggesting that the effect of epinephrine was only observed in the HL group under acute stress conditions. Similarly, the same epinephrine doses co-administered with insulin increased the receptor density in both subpopulations and also showed that the highest dose of epinephrine did not further increase the maximum density of GABA(A)R in HL chicks. These results suggest that systemic epinephrine, perhaps by evoking central norepinephrine release, modulated the increase in the forebrain GABA(A) receptor recruitment induced by both insulin and stress in different ways depending on the subpopulation fearfulness. Copyright © 2013 Elsevier Inc. All rights reserved.

Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine.

PubMed

Replogle, K; Reader, A; Nist, R; Beck, M; Weaver, J; Meyers, W J

1999-05-01

Because a number of patients have reported an increase in heart rate with the intraosseous, or i.o., injection, it is important to evaluate changes in the cardiovascular system with this injection technique. The purpose of this study was to determine the cardiovascular effects of an i.o. injection of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. With the use of a repeated-measures design, the authors randomly assigned 42 subjects to receive i.o. injections of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine or 1.8 mL of 3 percent mepivacaine in a double-blinded manner at two appointments. At each appointment the authors monitored electrocardiographic findings, cardiac rate, systolic and diastolic blood pressure, and mean arterial pressure before, during and after administration of anesthetic solutions. With the 2 percent lidocaine with 1:100,000 epinephrine solution, 28 (67 percent) of 42 subjects experienced an increase in heart rate that might be attributed to the effect of the epinephrine. In 22 (79 percent) of these subjects, the heart rate returned to within 5 beats of baseline values within four minutes after solution deposition. The authors found no significant increase in heart rate in subjects receiving the 3 percent mepivacaine. No significant differences (P > .05) were found in mean diastolic, mean systolic or mean arterial blood pressure values between the subjects receiving 2 percent lidocaine with 1:100,000 epinephrine and those receiving 3 percent mepivacaine. The majority of subjects receiving the i.o. injection of the 2 percent lidocaine-epinephrine solution experienced a transient increase in heart rate. No significant increase in heart rate was seen with the i.o. injection of 3 percent mepivacaine. While patients would likely notice the heart rate increase with the lidocaine-epinephrine solution, it would not be clinically significant in most healthy patients. In patients whose medical condition, drug therapies or epinephrine sensitivity suggests caution, 3 percent mepivacaine is a good alternative for i.o. injections.

Prevention of thiopental and thiopental/halothane cardiac sensitization to epinephrine in the sheep.

PubMed Central

Rezakhani, A; Edjtehadi, M; Szabuniewicz, M

1977-01-01

The effects of epinephrine (5 microgram/kg of body weight) on ten unanesthetized sheep were experimentally tested: all sheep displayed serious arrhythmias. Sheep anesthetized with thiopental and thiopental/halothane combination displayed cardiac arrhythmias of the order of 10% and 20% respectively. Challenge injections of epinephrine (5 microgram/kg of body weight) to ten sheep anesthetized with thiopental, and to the same number of animals after 45 minutes of anesthesia with thiopental/halothane, produced serious arrhythmias. However, following preanesthetic treatment with acepromazine maleate (0.5 mg/kg) to 15 sheep, serious arrhythmias were prevented in all of them when they were given arrhythmic doses of epinephrine. Images Fig. 2. PMID:922556

Direct effects of recurrent hypoglycaemia on adrenal catecholamine release.

PubMed

Orban, Branly O; Routh, Vanessa H; Levin, Barry E; Berlin, Joshua R

2015-01-01

In Type 1 and advanced Type 2 diabetes mellitus, elevation of plasma epinephrine plays a key role in normalizing plasma glucose during hypoglycaemia. However, recurrent hypoglycaemia blunts this elevation of plasma epinephrine. To determine whether recurrent hypoglycaemia affects peripheral components of the sympatho-adrenal system responsible for epinephrine release, male rats were administered subcutaneous insulin daily for 3 days. These recurrent hypoglycaemic animals showed a smaller elevation of plasma epinephrine than saline-injected controls when subjected to insulin-induced hypoglycaemia. Electrical stimulation of an adrenal branch of the splanchnic nerve in recurrent hypoglycaemic animals elicited less release of epinephrine and norepinephrine than in controls, without a change in adrenal catecholamine content. Responsiveness of isolated, perfused adrenal glands to acetylcholine and other acetylcholine receptor agonists was also unchanged. These results indicate that recurrent hypoglycaemia compromised the efficacy with which peripheral neuronal activity stimulates adrenal catecholamine release and demonstrate that peripheral components of the sympatho-adrenal system were directly affected by recurrent hypoglycaemia. © The Author(s) 2014.

Novel fluorimetric assay of trace analysis of epinephrine in human serum

NASA Astrophysics Data System (ADS)

Adeniyi, William K.; Wright, Ashleigh R.

2009-12-01

A simple, rapid, and sensitive spectrofluorimetric technique for the microdetermination of epinephrine in human serum is described. The investigation shows that trace amounts of epinephrine, antidepressant of clinical importance, can be determined without the conventional derivatization or use of fluorophores by diazotization. The method is based on the optimization of experimental parameters, such as pH, temperature, careful selection of excitation and emission wavelengths and on the use of anionic surfactant, sodium dodecyl sulfate (SDS), to enhance sensitivity. The measurement was carried out at 360 nm with excitation at 286 nm. Under the optimum conditions, a linear relationship was obtained between the fluorescence intensity and epinephrine concentration in the range of 0.10 and 1.0 μg/mL; the correlation coefficient and detection limit are 0.9953 and 0.05 μg/mL, respectively. Recovery tests indicated an efficiency of 95.5-98.7% by using known amounts of epinephrine spiked with human serum.

Induction of cell expansion of goldfish melanocytoma cells (GMM-1) by epinephrine and dexamethasone requires external calcium.

PubMed

Shih, Y L; Lo, S J

1993-05-01

Treatment of GMM-1 (a goldfish melanocytoma cell line) cells with epinephrine induced a rapid cell expansion (flattening of cells, extension and broadening of cellular processes) similar to the effect of dexamethasone reported previously (Shih et al., 1990). Studies on the possible involvement of secondary messengers in cell expansion indicated that (i) both 8-bromo-CAMP and forskolin caused cell shrinking (the opposite of cell expansion); (ii) TPA also caused cell shrinking; (iii) phospholipid derivatives, such as 1,2-dioctanoyl-sn-glycerol, lysophosphatidic acid, and arachidonic acid caused cell expansion; and (iv) EGTA (calcium chelator) and nifedipine (calcium channel blocker) inhibited the effect of epinephrine. Together with the previous findings, these observations indicate that epinephrine and dexamethasone may share a common pathway in triggering an external calcium influx to cause cell expansion. The results of the effects of epinephrine agonists and antagonists, together with those of other workers, also show that there are multiple isoforms of adrenoceptor in the goldfish.

Highly selective aptamer based organic electrochemical biosensor with pico-level detection.

PubMed

Saraf, Nileshi; Woods, Eric R; Peppler, Madison; Seal, Sudipta

2018-05-22

An organic aptamer functionalized electrochemical transistor has been developed to detect the presence of epinephrine molecule which acts as an excitatory neurotransmitter. The abnormalities in the level of epinephrine are the direct symptoms of some diseases such as Takotsubo cardiomyopathy, myocardial infarction, arrhythmias and other heart related diseases. The present approach is based on immobilization of aptamers on the gate electrode which selectively binds to epinephrine with high affinity. The introduction of epinephrine in the system causes screening of negative charge of aptamers as well as the production of Faradaic current due to oxidation of epinephrine. The synergistic effect of these two events decreases the overall channel current which was seen in both transfer characteristics and current-time curve. Additional experiments against common interfering agents (dopamine, ascorbic acid, DOPAC etc) showed no decrease in the current which indicates high specificity of the sensor. Overall, the incorporation of aptamers in the transistor has allowed us to obtain a sensor exhibiting the lowest limit of detection for epinephrine (90 pM) till date which is comparable to normal physiological level. This approach provides a real-time detection of a large range of biomolecules and viral proteins in a time and cost-effective manner and has applications in point-of-care testing tool for several diagnostic applications. Published by Elsevier B.V.

Effects of epinephrine on lidocaine pharmacokinetics and blood volume in the dental pulp.

PubMed

Hashimoto, Shuichi; Yamashiro, Mikiko; Fujita, Kyohei; Yasuda, Asako; Sunada, Katsuhisa

2014-09-01

Epinephrine potentiates and prolongs the efficacy of local anesthetics by reducing blood flow. We investigated the effect of epinephrine on the pharmacokinetics of lidocaine and the pulpal blood volume after maxillary infiltration anesthesia in rats. We measured the (14)C-radioactivity and (14)C-distribution in the maxilla and the dental pulp after the injection of 2% (14)C-lidocaine with or without 10 μg/mL epinephrine (n = 7) into the palatine mucosa proximal to the first molar. The blood volume in the pulp was measured using (99m)Tc-pertechnetate (n = 5). When lidocaine was injected together with epinephrine, the lidocaine became widely distributed throughout the maxilla and was observed mainly in the first molar pulp. The lidocaine amount in the dental pulp at 10-60 minutes was more than 2 times higher than that after the injection of lidocaine alone. The relative pulpal blood volume after 20 minutes decreased to 63.1% of the value after the injection of lidocaine alone. We found that lidocaine had infiltrated into the molar pulp after infiltration anesthesia. Furthermore, our results suggested that epinephrine augmented the retention of lidocaine in the pulp. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Sound stress-induced long-term enhancement of mechanical hyperalgesia in rats is maintained by sympathoadrenal catecholamines.

PubMed

Khasar, Sachia G; Dina, Olayinka A; Green, Paul G; Levine, Jon D

2009-10-01

Although stress plays an important role in chronic widespread pain syndromes, such as fibromyalgia, the underlying mechanism has remained elusive. We have recently demonstrated, in a model of chronic widespread pain, that prolonged enhancement of immune mediator hyperalgesia, induced by unpredictable sound stress, requires a contribution of both the sympathoadrenal (epinephrine) and the hypothalamic-pituitary adrenal (corticosterone) neuroendocrine stress axes. Because this stress protocol produced sustained elevation of plasma epinephrine, in the current study we tested the hypothesis that the sympathoadrenal axis also plays a role in maintenance of symptoms in this model of chronic widespread pain. After establishment, adrenal medullectomy abolished the enhancement of epinephrine-induced cutaneous and muscle hyperalgesia. Administration of stress levels of epinephrine to adrenal medullectomized rats reconstituted the pain phenotype. These observations suggest that the sympathoadrenal stress axis plays a major role in the induction as well as maintenance of stress-induced enhancement of mechanical hyperalgesia, mediated by prolonged elevation of circulating epinephrine. We present data showing mechanical hyperalgesia persisting for up to 28 days after exposure to sound stress, with evidence that the sympathoadrenal axis mediator epinephrine plays a major role. These findings could have clinical implications with regard to novel potential treatments for chronic widespread pain syndromes, such as fibromyalgia.

Epinephrine in cardiac arrest: systematic review and meta-analysis

PubMed Central

Morales-Cané, Ignacio; Valverde-León, María Del Rocío; Rodríguez-Borrego, María Aurora

2016-01-01

abstract Objective: evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method: systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results: when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion: administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status. PMID:27982306

The Addition of Epinephrine to Proxymetacaine or Oxybuprocaine Solution Increases the Depth and Duration of Cutaneous Analgesia in Rats.

PubMed

Chen, Yu-Wen; Chiu, Chong-Chi; Kan, Chung-Dann; Wang, Jhi-Joung; Hung, Ching-Hsia

2016-01-01

The aim of this experiment was to investigate the interaction between epinephrine and 2 local anesthetics (proxymetacaine or oxybuprocaine) using subcutaneous injections under the hairy skin, thereby simulating infiltration blocks. Using a rat model of cutaneous trunci muscle reflex in response to local skin pinpricks, the anesthetic properties of proxymetacaine and oxybuprocaine alone and in combination with epinephrine as an infiltrative anesthetic were tested. Isobolographic analysis was used for the analgesic interactions between adjuvant epinephrine and the local anesthetics. Lidocaine was used as a control group. Oxybuprocaine, proxymetacaine, and lidocaine elicited a dose-dependent block to pinpricks. On the 50% effective dose (ED50) basis, their relative potencies were proxymetacaine [0.126 (0.113-0.141) μmol] greater than oxybuprocaine [0.208 (0.192-0.226) μmol] greater than lidocaine [6.331 (5.662-7.079) μmol] (P < 0.01 for each comparison). On an equipotent basis (ED25, ED50, and ED75), sensory block duration elicited by oxybuprocaine or proxymetacaine was greater than that elicited by lidocaine (P < 0.01). Coadministration of proxymetacaine, oxybuprocaine, or lidocaine with epinephrine produced a synergistic analgesic effect and prolonged the cutaneous analgesic effect. After adding epinephrine, oxybuprocaine was much faster, reaching its maximal blockade, than proxymetacaine or lidocaine (P < 0.01). We concluded that proxymetacaine and oxybuprocaine were more potent and produced greater duration of nociceptive block than lidocaine. The use of epinephrine augmented the potency and prolonged the duration of proxymetacaine, oxybuprocaine, and lidocaine as an infiltrative anesthetic.

Cardioactive and vasoactive effects of natural wild honey against cardiac malperformance induced by hyperadrenergic activity.

PubMed

Rakha, Miran K; Nabil, Zohour I; Hussein, Aida A

2008-03-01

Induction of hyperadrenergic activity was experimentally achieved in urethane-anesthetized rats using epinephrine (adrenaline). Acute administration of epinephrine (100 microg/kg) for 2 hours induced several cardiac disorders and vasomotor dysfunction. Pretreatment with natural wild honey (5 g/kg) for 1 hour prior to the injection with epinephrine (100 mug/kg) protected the anesthetized normal rats from the incidence of epinephrine-induced cardiac disorders and vasomotor dysfunction. Moreover, posttreatment with natural wild honey (5 g/kg) following the injection with epinephrine (100 microg/kg) for 1 hour showed several ameliorative outcomes to the electrocardiographic parameters and vasomotor dysfunction of anesthetized stressed rats. Furthermore, natural wild honey preserved the positive inotropic effect of epinephrine in both cases. Also, the total antioxidant capacity (AOC) of natural wild honey was found to be very pronounced. Levels of both reduced glutathione and ascorbic acid (vitamin C) were considered relatively high in natural wild honey. Activity of superoxide dismutase (SOD) was also high, whereas catalase activity was relatively low, especially when compared to the value of SOD activity. It would appear from the results of the present study that natural wild honey may exert its cardioprotective and therapeutic effects against epinephrine-induced cardiac disorders and vasomotor dysfunction directly, via its very pronounced total AOC and its great wealth of both enzymatic and nonenzymatic antioxidants involved in cardiovascular defense mechanisms, besides its substantial quantities of mineral elements such as magnesium, sodium, and chlorine, and/or indirectly, via the enhancement of the endothelium-derived relaxing factor nitric oxide release through the influence of ascorbic acid (vitamin C).

Influence of detomidine and xylazine on spleen dimensions and on splenic response to epinephrine infusion in healthy adult horses.

PubMed

Deniau, Valérie; Depecker, Marianne; Bizon-Mercier, Céline; Couroucé-Malblanc, Anne

2013-07-01

To compare the changes in splenic length and thickness and in packed cell volume (PCV) following detomidine or xylazine administration and subsequent epinephrine infusion. Spleen relaxation occurs following xylazine or detomidine administration and interferes with subsequent splenic contractile response to epinephrine. Randomized non-blinded crossover experimental study. 6 healthy adult mares. The mares received an intravenous (IV) epinephrine infusion (1 μg kg(-1 ) minute(-1) over 5 minutes) one hour after IV administration of detomidine (0.01 mg kg(-1) ), xylazine (0.5 mg kg(-1) ) or no drug (control), with a withdrawal period of at least 7 days between experiments. The splenic length measured in two different axes, the splenic thickness, and the PCV were measured prior to sedation (T0), 30 minutes later, and at 5-minute intervals from the start of the epinephrine infusion (T1) until T1 + 40 minutes. Changes from base-line and between treatments were compared using a two-way anova for repeated measures. Significance was set at p < 0.05. Splenic length was significantly increased and PCV was significantly decreased after detomidine administration compared to baseline. Epinephrine infusion resulted in a significant decrease in splenic length and thickness, and a significant increase in PCV, irrespective of prior treatment with detomidine or xylazine. Detomidine administration was followed by a sonographically detectable increase of splenic length. Neither detomidine nor xylazine interfered with the ability of the spleen to contract following subsequent administration of an epinephrine infusion given one hour later. Previous sedation with alpha-2 agonists does not preclude the efficiency of epinephrine as a medical treatment of left dorsal displacement of the large colon, but further investigations are required with other drug doses and different time intervals between administrations. © 2013 The Authors. Veterinary Anaesthesia and Analgesia © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Comparison of local anesthetics for digital nerve blocks: a systematic review.

PubMed

Vinycomb, Toby I; Sahhar, Lukas J

2014-04-01

To evaluate the time to onset of anesthesia, duration of anesthesia, and pain on injection of local anesthetics. A systematic search of the English literature was performed of the Medline, Cochrane Central Register of Controlled Trials, The Allied and Complementary Medicine Database (AMED), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, and 6 articles were complied with the study inclusion criteria. Six studies (335 nerve blocks) were included in our final analysis measuring 6 local anesthetic preparations (lidocaine, lidocaine with epinephrine, bupivacaine, bupivacaine with epinephrine, lidocaine with bupivacaine, and ropivacaine). Lidocaine demonstrated the shortest mean onset of anesthesia (3.1 min) and bupivacaine the longest (7.6 min). Lidocaine also demonstrated the shortest mean duration of anesthesia (1.8 h) and ropivacaine the longest mean duration (21.5 h). Lidocaine with epinephrine demonstrated the least mean pain on injection (26 mm on a visual analog scale) and bupivacaine with epinephrine the most mean pain (53 mm). Lidocaine with epinephrine provides a good short-term anesthesia and may reduce the risk of injury or complication while the finger in still anesthetized. Bupivacaine with lidocaine provides good long-term anesthesia and may reduce the need for postprocedural anesthesia. Ropivacaine likely provides the longest duration of anesthesia but the absence of epinephrine means a tourniquet must be used to create a bloodless field and thus is contraindicated in some procedures such as flexor tendon repairs where active testing may be required. Lidocaine with epinephrine, bupivacaine with epinephrine, and ropivacaine all provide benefits in digital nerve blocks. The surgeon may choose the most appropriate local anesthetic or combination of local anesthetics based on the procedure to be undertaken and the postoperative requirements. Therapeutic II. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Delivery of Epinephrine in the Vapor Phase for the Treatment of Croup.

PubMed

Leung, Kitty; Newth, Christopher J L; Hotz, Justin C; O'Brien, Kevin C; Fink, James B; Coates, Allan L

2016-04-01

The Vapotherm system delivers high humidity to the airway of patients by using semipermeable tubules where heated liquid water is in contact with air. The humidified air is conducted to the patient via a heated tube. Preliminary clinical observations in infants with croup suggested that epinephrine added to the water supplying the humidity was delivered successfully in the vapor phase. The purpose of this study was to evaluate the efficiency of the delivery of epinephrine in the vapor phase and to develop the feasibility criteria for a clinical pilot study. Thirty milligrams of epinephrine in a 1-L bag of sterile water was used as the humidification source for a Vapotherm 2000i. The output of the heated circuit was condensed and collected into a small Erlenmeyer flask via a metal coil while the whole collection system was submerged in an ice slurry to maintain the outflow temperature from the flask between 0°C and 2°C. The in vitro system was tested at 40°C with flows of 5, 10, and 15 L/min and L-epinephrine concentrations of 15, 30, and 60 mg/L. Each test was duplicated at each of the six conditions. Academic children's hospital research laboratory. None. None. The system recovered more than 90% of the water vapor from the fully saturated air at 40°C. The epinephrine concentration recovery quantified by ultraviolet-visible spectrophotometry was 23.9% (27.5-20.4%) (mean and range) of the initial concentration. At flows of 5, 10, and 15 L/min, the delivery of epinephrine would be 1.8, 3.6, and 4.2 μg/min, respectively, which is in the therapeutic range used for parenteral infusion in young children. The Vapotherm system can be used to deliver epinephrine in pharmacological doses to the respiratory system as a vapor and thus as an alternative to droplets by conventional nebulization.

Hydroxocobalamin and Epinephrine Both Improve Survival in a Swine Model of Cyanide-Induced Cardiac Arrest

DTIC Science & Technology

2012-10-01

Neurologic effects were not measured in this preliminary study. Oxygen therapy has been used as a sole treatment for cyanide toxicity; however, both groups...standardized mechanical chest compressions and were randomly assigned to receive one of 3 intravenous bolus therapies : hydroxocobalamin, epinephrine, or...arterial pressure and pH, decreased blood lactate and cyanide levels, and decreased the use of rescue epinephrine therapy compared with that in the

Epinephrine Policies and Protocols Guidance for Schools: Equipping School Nurses to Save Lives.

PubMed

Tanner, Andrea; Clarke, Carrie

2016-01-01

In response to limited direction given by legislative bodies to school nurses about how to implement state-mandated or recommended stock epinephrine programs in their schools, NASN convened a workgroup of invested stakeholders. This workgroup was challenged to equip school nurses with the necessary tools to develop policies and protocols regarding stock epinephrine in their school districts. The dynamic workgroup subcommittees focused on policies, procedures, and reporting tools. This article reviews the results of the subcommittees' work and the overall collaboration within the workgroup. This article provides clear, nationally recognized guidance on the best practice for establishing stock epinephrine policies and protocols with reporting tools at the local school district level. © 2015 The Author(s).

Effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, C.G.; Werman, H.A.; Davis, E.A.

1987-02-01

Although epinephrine has been shown to improve myocardial blood flow during cardiopulmonary resuscitation (CPR), the effects of standard as well as larger doses of epinephrine on regional myocardial blood flow have not been examined. In this study we compared the effects of various doses of epinephrine on regional myocardial blood flow after a 10 min arrest in a swine preparation. Fifteen swine weighing greater than 15 kg each were instrumented for regional myocardial blood flow measurements with tracer microspheres. Regional blood flow was measured during normal sinus rhythm. After 10 min of ventricular fibrillation, CPR was begun and regional myocardialmore » blood flow was determined. Animals were then randomly assigned to receive 0.02, 0.2, or 2.0 mg/kg epinephrine by peripheral injection. One minute after drug administration, regional myocardial blood flow measurements were repeated. The adjusted regional myocardial blood flows (ml/min/100 g) for animals given 0.02, 0.2, and 2.0 mg/kg epinephrine, respectively, were as follows: left atrium, 0.9, 67.4, and 58.8; right atrium, 0.3, 46.2, and 38.5; right ventricle, 0.7, 82.3, and 66.9; right interventricular septum, 1.7, 125.5, and 99.1; left interventricular septum, 2.8, 182.8, 109.5; mesointerventricular septum, 16.8, 142.2, and 79.2; left ventricular epicardium, 19.2, 98.5 and 108.7; left ventricular mesocardium, 22.8, 135.0, and 115.8; and left ventricular endocardium, 2.5, 176.1, and 132.9). All comparisons between the groups receiving 0.02 and 0.2 mg/kg epinephrine were statistically significant (p less than .05).« less

Prescriptions for self-injectable epinephrine and follow-up referral in emergency department patients presenting with anaphylaxis.

PubMed

Campbell, Ronna L; Luke, Anuradha; Weaver, Amy L; St Sauver, Jennifer L; Bergstralh, Eric J; Li, James T; Manivannan, Veena; Decker, Wyatt W

2008-12-01

Anaphylaxis guidelines recommend that patients with a history of anaphylactic reaction should carry self-injectable epinephrine and should be referred to an allergist. To evaluate how frequently patients dismissed from the emergency department after treatment for anaphylaxis received a prescription for self-injectable epinephrine or allergist referral. A retrospective medical record review identified patients with anaphylaxis in a community-based study from 1990 through 2000. Records of patients with Hospital Adaptation of the International Classification of Diseases, Second Edition or International Classification of Diseases, Ninth Revision codes representing anaphylaxis were reviewed, and a random sample of patients with associated diagnoses was also reviewed. Patients who met the criteria for diagnosis of anaphylaxis were included in the study. Among 208 patients identified with anaphylaxis, 134 (64.4%) were seen in the emergency department and discharged home. On dismissal, 49 patients (36.6%; 95% confidence interval [CI], 28.4%-44.7%) were prescribed self-injectable epinephrine, and 42 patients (31.3%; 95% CI, 23.5%-39.2%) were referred to an allergist. Treatment with epinephrine in the emergency department (odds ratio, 3.6; 95% CI, 1.6-7.9; P = .001) and insect sting as the inciting allergen (odds ratio, 4.0; 95% CI, 1.6-10.5; P = .004) were significantly associated with receiving a prescription for self-injectable epinephrine. Patient age younger than 18 years was the only factor associated with referral to an allergist (P = .007). Most patients dismissed after treatment for anaphylaxis did not receive a self-injectable epinephrine prescription or allergist referral. Emergency physicians may be missing an important opportunity to ensure prompt treatment of future anaphylactic reactions and specialized follow-up care.

Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department.

PubMed

Robinson, Melissa; Greenhawt, Matthew; Stukus, David R

2017-08-01

Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel. To evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC). We performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013. A total of 408 patients (mean age, 7.25 years; 62% male) were included for analysis. Only 148 patients (36.3%) received epinephrine before arrival at the ED or UCC. Reactions occurring at home (n = 36/114) were less likely to be treated with epinephrine compared with reactions occurring at school (n = 30/49) (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15-0.59). The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system (OR, 0.50; 95% CI, 0.30-0.85) or 3-organ system (OR, 0.41; 95% CI, 0.21-0.81) presentation compared with 1-organ system involvement. Foods (342 [83.8%]) were the most commonly reported provoking trigger. Patients who did not receive epinephrine before arrival at the ED or UCC were significantly less likely to be discharged to home (OR, 0.56; 95% CI, 0.37-0.86; P = .01). This study identifies factors associated with prehospital management of anaphylaxis for children, which highlight that epinephrine administration may be occurring with considerable delay. Increased awareness and education of caregivers, patients, and medical professionals are necessary to provide optimal management. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Preoperative flap-site injection with ropivacaine and epinephrine in BABA robotic and endoscopic thyroidectomy safely reduces postoperative pain: A CONSORT-compliant double-blinded randomized controlled study (PAIN-BREKOR trial).

PubMed

Lee, Joon-Hyop; Suh, Yong Joon; Song, Ra-Yeong; Yi, Jin Wook; Yu, Hyeong Won; Kwon, Hyungju; Choi, June Young; Lee, Kyu Eun

2017-06-01

Clinical trials on bilateral axillo-breast approach (BABA) thyroidectomy show that levobupivacaine and ropivacaine significantly reduce postoperative pain, but they focused on BABA robotic thyroidectomy only and did not identify specific sites of significant pain relief. Our objective was to assess the pain reduction at various sites and safety of ropivacaine-epinephrine flap injection in BABA thyroidectomy. This prospective double-blinded randomized controlled trial was conducted in compliance with the revised CONSORT statement (ClinicalTrials.gov registration no. NCT02112370). Patients were randomized into the ropivacaine-epinephrine arm or control (normal saline) arm. From January 2014 to May 2016, 148 patients participated. The primary endpoint was site-specific pain, as measured by numeric rating scale 12 hours after surgery. The ropivacaine-epinephrine group exhibited significantly less swallowing difficulty (P = .008), anterior neck pain (P = .016), and right (P = .019) and left (P = .035) chest pain. Secondary endpoints were systolic (P = .402), diastolic (P = .827) blood pressure, and pulse rate (P = .397) after injection before incision and during surgery. The vital signs of the groups just after injection did not differ. During surgery, the ropivacaine-epinephrine patients had higher pulse rates (99 ± 13.3 vs 88 ± 16.1, P < .001) but within normal range. There were no adverse events such as postoperative nausea and vomiting. There was no significant difference in pain scores in either patient group between patients who underwent robotic or endoscopic interventions. BABA flap-site injection with ropivacaine and epinephrine mix before incision effectively and safely reduced postoperative pain. Future studies should focus on tailoring ropivacaine and epinephrine dosage for individuals.

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks

PubMed Central

Whitcomb, Michael; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

2010-01-01

Abstract The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10–71%. For the unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10–72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1 : 100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1 : 100,000 epinephrine for an IAN block. PMID:20553136

Epinephrine for First-aid Management of Anaphylaxis.

PubMed

Sicherer, Scott H; Simons, F Estelle R

2017-03-01

Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specific circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confirmation of the trigger, discussion of specific allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and first-aid treatment. Copyright © 2017 by the American Academy of Pediatrics.

Volume of Anesthetic in 0.5% Marcaine with 1:200,000 Epinephrine Dental Carpule

DTIC Science & Technology

2016-04-01

copyrighted material in the thesis manuscript entitled: "Volume of Anesthetic in 0.5% Marcaine with 1:200,000 Epinephrine Dental Carpule" Is...3. School/DepartmenUCenter: Army Postgraduate Dental School, AEGD-2 Program, Fort Hood, TX 4. Phone: (708) 227-2152 5. Type of clearance...X_Thesis _Article _Book _Poster _Presentation _Other 6. Title: "Volume of Anesthetic in 0.5% Marcaine with 1:200,000 Epinephrine Dental Carpule

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis.

PubMed

Sood, Ravi; Hans, Manoj-Kumar; Shetty, Shashit

2014-12-01

This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient's subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis.

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis

PubMed Central

Sood, Ravi; Shetty, Shashit

2014-01-01

Objectives: This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Material and Methods: Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient’s subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. Results: The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Conclusions: Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis. PMID:25674319

An evaluation of the influence of medetomidine hydrochloride and atipamezole hydrochloride on the arrhythmogenic dose of epinephrine in dogs during halothane anesthesia.

PubMed Central

Pettifer, G R; Dyson, D H; McDonell, W N

1996-01-01

Alterations in the arrhythmogenic dose of epinephrine (ADE) were determined following administration of medetomidine hydrochloride (750 micrograms/M2) and a saline placebo, or medetomidine hydrochloride (750 micrograms/M2), followed by specific medetomidine reversal agent, atipamezole hydrochloride (50 micrograms/kg) 20 min later, in halothane-anesthetized dogs (n = 6). ADE determinations were made prior to the administration of either treatment, 20 min and 4 h following medetomidine/saline or medetomidine/atipamezole administration. Epinephrine was infused for 3 min at increasing dose rates (2.5 and 5.0 micrograms/kg/min) until the arrhythmia criterion (4 or more intermittent or continuous premature ventricular contractions) was reached. The interinfusion interval was 20 min. There were no significant differences in the amount of epinephrine required to reach the arrhythmia criterion following the administration of either treatment. In addition, the ADE at each determination was not different between treatment groups. In this study, the administration of medetomidine to halothane-anesthetized dogs did not alter their arrhythmogenic response to infused epinephrine. PMID:8825986

Posttraining Epinephrine Reverses Memory Deficits Produced by Traumatic Brain Injury in Rats

PubMed Central

Lorón-Sánchez, Alejandro; Torras-Garcia, Meritxell; Coll-Andreu, Margalida; Costa-Miserachs, David; Portell-Cortés, Isabel

2016-01-01

The aim of this research is to evaluate whether posttraining systemic epinephrine is able to improve object recognition memory in rats with memory deficits produced by traumatic brain injury. Forty-nine two-month-old naïve male Wistar rats were submitted to surgical procedures to induce traumatic brain injury (TBI) or were sham-operated. Rats were trained in an object recognition task and, immediately after training, received an intraperitoneal injection of distilled water (Sham-Veh and TBI-Veh group) or 0.01 mg/kg epinephrine (TBI-Epi group) or no injection (TBI-0 and Sham-0 groups). Retention was tested 3 h and 24 h after acquisition. The results showed that brain injury produced severe memory deficits and that posttraining administration of epinephrine was able to reverse them. Systemic administration of distilled water also had an enhancing effect, but of a lower magnitude. These data indicate that posttraining epinephrine and, to a lesser extent, vehicle injection reduce memory deficits associated with TBI, probably through induction of a low-to-moderate emotional arousal. PMID:27127685

The efficacy and safety of epinephrine for postoperative bleeding in total joint arthroplasty

PubMed Central

Teng, Yanbin; Ma, Jianxiong; Ma, Xinlong; Wang, Ying; Lu, Bin; Guo, Chaowei

2017-01-01

Abstract Background: Total joint arthroplasty (TJA) usually results in postoperative bleeding. Some randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) have been performed to evaluate the effects of epinephrine on postoperative bleeding after TJA. However, this remained controversial about the efficacy and safety of epinephrine for postoperative bleeding in TJA. The objective of our meta-analysis was to compare the overall effect and safety of epinephrine and placebo for postoperative bleeding in TJA. Methods: PubMed, Embase, and the Cochrane Library were searched to identify potentially relevant articles. RCTs or non-RCTs involving epinephrine and placebo for blood loss in total knee arthroplasty or total hip arthroplasty were included. Our study was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RevMan v5.3 was used to analyze the relevant data. Results: Four RCTs and 1 non-RCT involving 646 participants met the inclusion criteria. The overall pooled results from meta-analysis demonstrated that compared with control groups, epinephrine groups could significantly reduce the postoperative bleeding volume (mean difference [MD] = −168.42, 95% confidence interval [CI]: −272.37 to −64.47, P = 0.001). There was no significant difference in intraoperative bleeding volume between epinephrine and control groups (MD = −12.89, 95% CI: −53.45 to 27.69, P = 0.53). No significant difference was found between 2 groups in terms of postoperative hemoglobin loss (MD = −0.28, 95% CI: −0.66 to 0.10, P = 0.15). Compared with the control groups, no statistically significant difference was found in terms of postoperative transfusion rate in epinephrine groups (relative risk [RR] 0.86, 95% CI: 0.64–1.15, P = 0.31). In addition, the results of the meta-analysis also indicated no significant difference in terms of the incidence rate of deep venous thrombosis (DVT) between 2 groups (RR 0.28, 95% CI: 0.05–1.64, P = 0.16). Conclusion: The meta-analysis showed that epinephrine could significantly reduce postoperative bleeding volume in TJA without increasing the incidence of DVT. However, there was no significant reduction in intraoperative bleeding volume, postoperative hemoglobin loss, and transfusion rate after the administration of epinephrine. Limitations: In this study, a higher heterogeneity and a risk of selection bias may be present in postoperative hemoglobin loss. In addition, the sample size of the included studies was too small, so our findings need to be further validated with more high-quality and larger scale RCTs in the future. Systematic review registration number: None. PMID:28445306

Canadian allergists' and nonallergists' perception of epinephrine use and vaccination of persons with egg allergy.

PubMed

Desjardins, Marylin; Clarke, Ann; Alizadehfar, Reza; Grenier, Danielle; Eisman, Harley; Carr, Stuart; Vander Leek, Timothy K; Teperman, Lee; Higgins, Niamh; Joseph, Lawrence; Shand, Greg; Ben-Shoshan, Moshe

2013-01-01

Studies suggest knowledge gaps about epinephrine use and vaccination of persons with egg allergy. We compared the perception of Canadian allergists and nonallergists on issues related to epinephrine use and vaccination of persons with egg allergy. Canadian allergists, pediatricians, general practitioners/family physicians and emergency room physicians were recruited through medical associations and surveyed on these issues. Multivariate logistic regression models were used to identify determinants of specific responses. One-hundred fourteen allergists and 613 nonallergists participated. For most issues with accepted best practices, allergists were more likely to adhere to recommendations. Allergists versus nonallergists were more likely to recommend intramuscular epinephrine for anaphylaxis (odds ratio [OR] = 3.8; 95% CI, 1.43-10.11). Older physicians (OR = 0.98; 95% CI, 0.97-0.99), Canadian-Paediatric-Surveillance-Program participants (OR = 0.48; 95% CI, 0.24-0.96), family physicians (OR = 0.39; 95% CI, 0.16-0.96), and general practitioners (OR = 0.14; 95% CI, 0.04-0.52) were less likely to recommend intramuscular use. However, in severe anaphylaxis, >25% of both groups would not give epinephrine for patients presenting with breathing difficulties or hypotension. Use of epinephrine for severe anaphylaxis was less likely in older physicians (OR = 0.97; 95% CI, 0.95-0.99), female physicians (OR = 0.60; 95% CI, 0.39-0.89), and those practicing in Ontario (OR = 0.56; 95% CI, 0.36-0.86), Manitoba (OR = 0.42; 95% CI, 0.19-0.90), or Nova-Scotia (OR = 0.31; 95% CI, 0.12-0.78). Allergists (OR = 6.22; 95% CI, 3.60-10.72) and physicians treating mainly children (OR = 3.41; 95% CI, 1.87-6.25), or practicing in Quebec (OR = 1.68; 95% CI, 1.12-2.55) were more likely to recommend measles-mumps-rubella vaccination in a community facility. Knowledge gaps about mode and indications for epinephrine administration and vaccination policies need to be addressed in future education programs to ensure prompt epinephrine use and to avoid unnecessary restriction of vaccines. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Pharmacokinetics of Lidocaine With Epinephrine Following Local Anesthesia Reversal With Phentolamine Mesylate

PubMed Central

Moore, Paul A; Hersh, Elliot V; Papas, Athena S; Goodson, J. Max; Yagiela, John A; Rutherford, Bruce; Rogy, Seigried; Navalta, Laura

2008-01-01

Phentolamine mesylate accelerates recovery from oral soft tissue anesthesia in patients who have received local anesthetic injections containing a vasoconstrictor. The proposed mechanism is that phentolamine, an alpha-adrenergic antagonist, blocks the vasoconstriction associated with the epinephrine used in dental anesthetic formulations, thus enhancing the systemic absorption of the local anesthetic from the injection site. Assessments of the pharmacokinetics of lidocaine and phentolamine, and the impact of phentolamine on the pharmacokinetics of lidocaine with epinephrine were performed to characterize this potentially valuable strategy. The blood levels of phentolamine were determined following its administration intraorally and intravenously. Additionally, the effects of phentolamine mesylate on the pharmacokinetics of intraoral injections of lidocaine with epinephrine were evaluated. Sixteen subjects were enrolled in this phase 1 trial, each receiving 4 drug treatments: 1 cartridge lidocaine/epinephrine followed after 30 minutes by 1 cartridge phentolamine (1L1P), 1 cartridge phentolamine administered intravenously (1Piv), 4 cartridges lidocaine/epinephrine followed after 30 minutes by 2 cartridges phentolamine (4L2P), and 4 cartridges lidocaine/epinephrine followed by no phentolamine (4L). Pharmacokinetic parameters estimated for phentolamine, lidocaine, and epinephrine included peak plasma concentration (Cmax), time to peak plasma concentration (Tmax), area under the plasma concentration-time curve from 0 to the last time point (AUClast) or from time 0 to infinity (AUCinf), elimination half-life (t1/2), clearance (CL), and volume of distribution (Vd). The phentolamine Tmax occurred earlier following the intravenous administration of 1Piv (7 minutes than following its submucosal administration in treatment 1L1P (15 minutes) or 4L2P (11 minutes). The phentolamine t1/2, CL, and Vd values were similar for 1L1P, 1Piv, and 4L2P. The Tmax for lidocaine occurred later and the Cmax for lidocaine was slightly higher when comparing the 4L2P treatment and the 4L treatment. The phentolamine-induced delay of the lidocaine Tmax likely represents phentolamine's ability to accelerate the systemic absorption of lidocaine from oral tissues into the systemic circulation. PMID:18547152

First Aid: Insect Stings and Bites

MedlinePlus

... epinephrine (EpiPen), give it right away, then call 911. Tell them your child is experiencing a life- ... someone is with you, have that person call 911 while you give the epinephrine. If your child ...

The efficacy of an elevated concentration of lidocaine HCl in impacted lower third molar surgery.

PubMed

Ping, Bushara; Kiattavorncharoen, Sirichai; Saengsirinavin, Chavengkiat; Im, Puthavy; Durward, Callum; Wongsirichat, Natthamet

2015-06-01

There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.

Development of a fast dissolving film of epinephrine hydrochloride as a potential anaphylactic treatment for pediatrics.

PubMed

Alayoubi, Alaadin; Haynes, Lindsay; Patil, Hemlata; Daihom, Baher; Helms, Richard; Almoazen, Hassan

2017-12-01

To develop a fast dissolving film strip containing epinephrine HCl for the potential treatment of pediatric anaphylaxis. Four different films have been prepared by solvent casting technique where the percentages of the polymer (Lycoat RS720) were optimized. The polymer percentages were (20%, 25%, 27% and 30%) of the total formulation weighs. The thickness and elastic modulus of the optimized film was evaluated using dynamic mechanical analyzer. Epinephrine content uniformity was assessed using UV at wavelength 280 nm. For the dissolution test, fast dissolving films (FDFs) were evaluated in 500 Simulated Saliva, with 50 rpm. In vivo taste and disintegration evaluation was performed on six healthy volunteers. Films formed by formulations 1, 2 and 3 were too sticky after drying, while formulation 4 that has 30% polymer content formed smooth, transparent, flexible and uniform film, and therefore, it was selected for further testing. The value of elastic modulus was determined at 1.325 MPa. The thickness of the film at different locations was measured at 0.29 mm. Drug content in film was measured at 93% ±10. More than 90% of epinephrine was released from the film within 7.2 min. Bitterness of epinephrine was masked efficiently according to volunteer's comments with average disintegration time of 20 s. This study presents potential proof for using FDFs as a replacement therapy of epinephrine injections for pediatrics.

Prevention of Anaphylaxis: The Role of the Epinephrine Auto-Injector.

PubMed

Fromer, Leonard

2016-12-01

Anaphylaxis is a life-threatening condition, with at-risk individuals remaining at chronic high risk of recurrence. Anaphylaxis is frequently underrecognized and undertreated by healthcare providers. The first-line pharmacologic intervention for anaphylaxis is epinephrine, and guidelines uniformly agree that its prompt administration is vital to prevent progression, improve patient outcomes, and reduce hospitalizations and fatalities. Healthcare costs potentially associated with failure to provide epinephrine (hospitalizations and emergency department visits) generally exceed those of its provision. At-risk patients are prescribed epinephrine auto-injectors to facilitate timely administration in the event of an anaphylactic episode. Despite guideline recommendations that patients carry 2 auto-injectors at all times, a significant proportion of patients fail to do so, with cost of medicine cited as one reason for this lack of adherence. With the increase of high-deductible healthcare plans, patient adherence to recommendations may be further affected by increased cost sharing. The recognition and classification of epinephrine as a preventive medicine by both the US Preventive Services Task Force and insurers could increase patient access, improve outcomes, and save lives. Copyright © 2016 The Author. Published by Elsevier Inc. All rights reserved.

Regulation of ODC activity in the thymus and liver of rats by adrenal hormones.

PubMed

Zahner, S L; Prahlad, K V; Mitchell, J L

1986-01-01

The activity of L-ornithine decarboxylase (EC 4.1.1.17, ODC) has become a useful indicator of hormone responsiveness. Various regimens of dexamethasone, aldosterone and epinephrine, alone or in combination, were administered to adrenalectomized rats either in acute or chronic doses. In addition, adrenalectomized rats, which were chronically treated with aldosterone and epinephrine, were given a single injection of 50 micrograms dexamethasone and sacrificed at various time intervals after hormone treatment. Hepatic and thymic ODC activity was measured. The expected dexamethasone effect, an increase in hepatic and a decrease in thymic ODC, was observed. This study also revealed that aldosterone induced similar responses in these tissues. Epinephrine had the opposite effect since chronic administration of dexamethasone or aldosterone with epinephrine resulted in control levels of ODC. Furthermore, when aldosterone and epinephrine were chronically administered to adrenalectomized rats, to study the acute effects of dexamethasone on rat thymus and liver, the time course of the response in each tissue was found to be distinct. The influence of the adrenal gland on rat thymus and liver is not restricted only to glucocorticoids, but may also involve other hormones which it secretes.

Anesthetic duration of lidocaine with 10% dextran is comparable to lidocaine with 1:160 000 epinephrine after intraosseous injection in the rabbit.

PubMed

Ito, Emiko; Ichinohe, Tatsuya; Shibukawa, Yoshiyuki; Aida, Hidetaka; Kaneko, Yuzuru

2007-09-01

To compare the effects of 10% dextran and epinephrine on intraosseous injection with lidocaine in rabbits. Twenty male Japanese white rabbits were used. The effect of intraosseous injection was evaluated using an electromyogram (EMG) of the digastric muscle after electrical pulp stimulation. Two percent lidocaine alone (L), 2% lidocaine containing 1:80000 epinephrine (LE8), 2% lidocaine containing 1:160 000 epinephrine (LE16), and 2% lidocaine containing 10% dextran (LD) were tested. Electromyogram recordings were repeated before and 30 seconds, 1, 2, 3, 4, 5, 7, 10, 12, 15, and 20 minutes after the intraosseous injection. Thereafter, recordings were repeated every 5 minutes until the EMG recovered to the control value. There was no difference in the onset time between the 4 groups. The order of the duration of maximum effect was LE8 >LE16 = LD >or=L. The order of the duration of anesthesia was LE8 >LE16 = LD >L. Ten percent dextran potentiates local anesthetic effects of 2% lidocaine in intraosseous injection. The potency of 10% dextran is comparable to 1:160 000 epinephrine.

Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases.

PubMed

Cho, Seung Hyun; Yi, Jin Woong; Kwack, Yoon Ho; Park, Sung Wook; Kim, Mi Kyeong; Rhee, Yong Girl

2010-03-01

We routinely have performed arthroscopic shoulder surgery under general anesthesia in the beach chair position using epinephrine (0.33 mg/L) saline irrigation. At a 2-week interval, two patients, a 19-year-old man scheduled to undergo an arthroscopic Bankart repair for left traumatic anterior instability and a 49-year-old woman scheduled for an arthroscopic rotator cuff repair for a left rotator cuff tear, were resuscitated by chest compression and defibrillation due to a sudden developed cardiogenic shock following ventricular tachycardia at the time of arthroscopic shoulder surgery. They were transferred to the intensive care unit because their emergent echocardiogram showed significantly decreased cardiac functions. They were fully recovered and then discharged. Epinephrine was considered to be the cause of ventricular tachycardia because the two patients showed no anaphylactic reaction to drugs or symptoms of air embolism related to the beach chair position. In addition, according to our observation of epinephrine flow patterns, it was more likely that highly concentrated epinephrine was rapidly infused into the body. This complication is very rare. However, thorough understanding of the side effects and their development of epinephrine during arthroscopic shoulder surgery should neither be overemphasized nor disregarded.

Epinephrine and exercise

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During periods of stress, such as preparing to run in a race, the brain signals the adrenal glands to produce epinephrine or "adrenaline". ... to react. As a longer term response to stress, cortisol is secreted by the adrenal glands, promoting ...

A critical role of acute bronchoconstriction in the mortality associated with high-dose sarin inhalation: Effects of epinephrine and oxygen therapies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gundavarapu, Sravanthi; Zhuang, Jianguo; Barrett, Edward G.

Sarin is an organophosphate nerve agent that is among the most lethal chemical toxins known to mankind. Because of its vaporization properties and ease and low cost of production, sarin is the nerve agent with a strong potential for use by terrorists and rouge nations. The primary route of sarin exposure is through inhalation and, depending on the dose, sarin leads to acute respiratory failure and death. The mechanism(s) of sarin-induced respiratory failure is poorly understood. Sarin irreversibly inhibits acetylcholine esterase, leading to excessive synaptic levels of acetylcholine and, we have previously shown that sarin causes marked ventilatory changes includingmore » weakened response to hypoxia. We now show that LD{sub 50} sarin inhalation causes severe bronchoconstriction in rats, leading to airway resistance, increased hypoxia-induced factor-1α, and severe lung epithelium injury. Transferring animals into 60% oxygen chambers after sarin exposure improved the survival from about 50% to 75% at 24 h; however, many animals died within hours after removal from the oxygen chambers. On the other hand, if LD{sub 50} sarin-exposed animals were administered the bronchodilator epinephrine, > 90% of the animals survived. Moreover, while both epinephrine and oxygen treatments moderated cardiorespiratory parameters, the proinflammatory cytokine surge, and elevated expression of hypoxia-induced factor-1α, only epinephrine consistently reduced the sarin-induced bronchoconstriction. These data suggest that severe bronchoconstriction is a critical factor in the mortality induced by LD{sub 50} sarin inhalation, and epinephrine may limit the ventilatory, inflammatory, and lethal effects of sarin. - Highlights: • Inhalation exposure of rats to LD{sub 50} sarin causes death through respiratory failure. • Severe bronchoconstriction is the major cause of sarin-induced respiratory failure. • Transfer of sarin exposed rats to 60% oxygen improves the mortality temporarily. • Epinephrine improves bronchoconstriction and mortality in LD{sub 50} sarin-exposed rats. • Both epinephrine and oxygen moderate the sarin-induced lung inflammatory response.« less

EPINEPHRINE OR GV-26 ELECTRICAL STIMULATION REDUCES INHALANT ANESTHESTIC RECOVERY TIME IN COMMON SNAPPING TURTLES (CHELYDRA SERPENTINA).

PubMed

Goe, Alexandra; Shmalberg, Justin; Gatson, Bonnie; Bartolini, Pia; Curtiss, Jeff; Wellehan, James F X

2016-06-01

Prolonged anesthetic recovery times are a common clinical problem in reptiles following inhalant anesthesia. Diving reptiles have numerous adaptations that allow them to submerge and remain apneic for extended periods. An ability to shunt blood away from pulmonary circulation, possibly due to changes in adrenergic tone, may contribute to their unpredictable inhalant anesthetic recovery times. Therefore, the use of epinephrine could antagonize this response and reduce recovery time. GV-26, an acupuncture point with reported β-adrenergic and respiratory effects, has reduced anesthetic recovery times in other species. In this prospective randomized crossover study, six common snapping turtles (Chelydra serpentina) were anesthetized with inhalant isoflurane for 90 min. Turtles were assigned one of three treatments, given immediately following discontinuation of isoflurane: a control treatment (0.9% saline, at 0.1 ml/kg i.m.), epinephrine (0.1 mg/kg i.m.), or acupuncture with electrical stimulation at GV-26. Each turtle received all treatments, and treatments were separated by 48 hr. Return of spontaneous ventilation was 55% faster in turtles given epinephrine and 58% faster in the GV-26 group versus saline (P < 0.001). The times to movement and to complete recovery were also significantly faster for both treatments than for saline (P < 0.02). Treated turtles displayed increases in temperature not documented in the control (P < 0.001). Turtles administered epinephrine showed significantly increased heart rates and end-tidal CO(2) (P < 0.001). No adverse effects were noted in the study animals. The mechanisms of action were not elucidated in the present investigation. Nevertheless, the use of parenteral epinephrine or GV-26 stimulation in the immediate postanesthetic period produces clinically relevant reductions in anesthetic recovery time in common snapping turtle. Further research is necessary to evaluate the effects of concurrent GV-26 and epinephrine administration and to assess responses in other reptilian species.

Clinical use of an epinephrine-reduced (1/400,000) articaine solution in short-time dental routine treatments--a multicenter study.

PubMed

Daubländer, Monika; Kämmerer, Peer W; Willershausen, Brita; Leckel, Michael; Lauer, Hans-Christoph; Buff, Siegmar; Rösl, Benita

2012-08-01

The addition of epinephrine in dental local anaesthesia results in a longer and deeper anaesthesia under almost ischemic conditions. For short-time dental treatments, epinephrine-reduced anaesthetics may offer shorter and more individual anaesthesia with reduced potential side effects. The aim of this study was a clinical evaluation of anaesthetic potency and adverse effects of an epinephrine-reduced articaine formulation in dental patients undergoing short-time routine treatment. In a prospective clinical, not interventional, study between January 2008 and February 2009, 908 patients undergoing short-time dental treatment in five medical centers were anaesthetized with 4% articaine 1:400,000 epinephrine (Ubistesin, 3M/ESPE, Seefeld, Germany). Efficacy and safety in clinical use were evaluated. A follow-up after 1 day was conducted by telephone survey. A mean amount of 1.3-ml anaesthetic solution was needed to achieve a complete or sufficient anaesthesia in 97% (n = 876) of cases. A second injection had to be done in 3.7% (n = 34) before and in 11.9% (n = 108) during treatment. Here, the second injection had to be applied after a mean of 48.6 min. The mean duration of soft tissue anaesthesia after infiltration was 146.6 min, after nerve block 187.7 min. The painful treatment took a mean of 50.2 min and the total treatment time summed up to 68.8 min. In 1.7% cases (n = 15), unwanted side effects were observed. The results indicate that a lower concentration of epinephrine in combination with the 4% articaine solution leads to a high success rate of efficacy. The clinical use of a 4% articaine 1:400,000 epinephrine solution can be stated as safe and effective in short dental routine treatments. Reconsiderations concerning limitations of indication or additional contraindications are not necessary.

A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth.

PubMed

Kanaa, Mohammad D; Whitworth, John M; Meechan, John Gerard

2012-04-01

The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth. This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL), or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analyzed by χ(2) and Fisher exact tests. Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001). IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

Utility of plasma free metanephrines in diagnosis of factitious pheochromocytoma.

PubMed

Chidakel, Aaron R; Pacak, Karel; Eisenhofer, Graeme; Lawrence, Jennifer E; Ayala, Alejandro R

2006-01-01

To report a case of epinephrine-induced factitious pheochromocytoma in a young woman with a past medical history of Conn's syndrome. We present a case report with clinical and laboratory details, review related reports in the literature, and demonstrate the usefulness of plasma free metanephrine levels in facilitating the diagnosis of factitious pheochromocytoma. A 34-year-old woman was admitted to our hospital for confirmation and localization of an occult pheochromocytoma. After thorough investigation, we discovered that the patient was surreptitiously injecting epinephrine in order to induce symptoms and signs consistent with a pheochromocytoma. Analysis of the patient's biochemical profile during and between her catecholaminergic crises revealed plasma epinephrine and free metanephrine levels that would be highly unusual for a patient with a pheochromocytoma. This case illustrates the utility of implementing the ratio of plasma epinephrine to free metanephrine levels in distinguishing factitious from organic pheochromocytoma.

Stimulation by epinephrine of the membrane transport of long chain fatty acid in the adipocyte

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abumrad, N.A.; Perry, P.R.; Whitesell, R.R.

1985-08-25

In isolated rat adipocytes, epinephrine rapidly stimulates the transport of long chain fatty acid across the plasma membrane. At a concentration of unbound oleate of 0.1 microM and 5 min exposure to the hormone, the minimal effective concentration of epinephrine is 0.03 and the optimal concentration 0.3 microM (0.01 and 0.1 microgram/ml). The stimulated rates are 5-10-fold the basal rate of influx or efflux. The hormone effect is on the transport process specifically as shown by isolation of the product of transport in either direction as unesterified fatty acid and inhibition by the transport inhibitors phloretin and 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid. Thismore » effect of epinephrine on transport coordinates physiologically with lipase activation to bring about fatty acid release from adipose tissue.« less

Interaction of berberine with human platelet. alpha. sub 2 adrenoceptors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hui, Ka Kit; Yu, Jun Liang; Chan, Wai Fong A.

1991-01-01

Berberine was found to inhibit competitively the specific binding of ({sup 3}H)-yohimbine. The displacement curve was parallel to those of clonidine, epinephrine, norepinephrine, with the rank order of potency (IC{sub 50}) being clonidine {gt} epinephrine {gt} norepinephrine (14.5 {mu}M) = berberine. Increasing concentrations of berberine from 0.1 {mu}M to 10 {mu}M inhibited ({sup 3}H)-yohimbine binding, shifting the saturation binding curve to the right without decreasing the maximum binding capacity. In platelet cyclic AMP accumulation experiments, berberine at concentrations of 0.1 {mu}M to 0.1 mM inhibited the cAMP accumulation induced by 10 {mu}M prostaglandin E{sub 1} in a dose dependent manner,more » acting as an {alpha}{sub 2} adrenoceptor agonist. In the presence of L-epinephrine, berberine blocked the inhibitory effect of L-epinephrine behaving as an {alpha}{sub 2} adrenoceptor antagonist.« less

Biosensor based on tyrosinase immobilized on a single-walled carbon nanotube-modified glassy carbon electrode for detection of epinephrine

PubMed Central

Apetrei, Irina Mirela; Apetrei, Constantin

2013-01-01

A biosensor comprising tyrosinase immobilized on a single-walled carbon nanotube-modified glassy carbon electrode has been developed. The sensitive element, ie, tyrosinase, was immobilized using a drop-and-dry method followed by cross-linking. Tyrosinase maintained high bioactivity on this nanomaterial, catalyzing the oxidation of epinephrine to epinephrine-quinone, which was electrochemically reduced (−0.07 V versus Ag/AgCl) on the biosensor surface. Under optimum conditions, the biosensor showed a linear response in the range of 10–110 μM. The limit of detection was calculated to be 2.54 μM with a correlation coefficient of 0.977. The repeatability, expressed as the relative standard deviation for five consecutive determinations of 10−5 M epinephrine solution was 3.4%. A good correlation was obtained between results obtained by the biosensor and those obtained by ultraviolet spectrophotometric methods. PMID:24348034

Secondary ventricular fibrillation or pulseless ventricular tachycardia during cardiac arrest and epinephrine dosing.

PubMed

Straznitskas, Andrew D; Wong, Sylvia; Kupchik, Nicole; Carlbom, David

2015-05-01

Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality. To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not. Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls. Of the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001). More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia. ©2015 American Association of Critical-Care Nurses.

Milrinone, dobutamine or epinephrine use in asphyxiated newborn pigs resuscitated with 100% oxygen.

PubMed

Joynt, Chloë; Bigam, David L; Charrois, Gregory; Jewell, Laurence D; Korbutt, Gregory; Cheung, Po-Yin

2010-06-01

After resuscitation, asphyxiated neonates often develop poor cardiac function with hypotension, pulmonary hypertension and multiorgan ischemia. In a swine model of neonatal hypoxia-reoxygenation, effects of epinephrine, dobutamine and milrinone on systemic, pulmonary and regional hemodynamics and oxygen transport were compared. Controlled, block-randomized study. University research laboratory. Mixed breed piglets (1-3 days, 1.5-2.3 kg). In acutely instrumented piglets, normocapnic alveolar hypoxia (10-15% oxygen) was induced for 2 h followed by reoxygenation with 100% oxygen (1 h) then 21% oxygen (3 h). At 2 h of reoxygenation, after volume loading (Ringer's lactate 10 ml/kg), either saline (placebo), epinephrine (0.5 microg/kg/min), dobutamine (20 microg/kg/min) or milrinone (0.75 microg/kg/min) were infused for 2 h in a blinded, block-randomized fashion (n = 6/group). All medications similarly improved cardiac output, stroke volume and systemic oxygen delivery (vs. placebo-controls, p < 0.05). Epinephrine and dobutamine significantly increased, while milrinone maintained, mean arterial pressure over pretreatment values while placebo-treated piglets developed hypotension and shock. The mean arterial to pulmonary arterial pressures ratio was not different among groups. All medications significantly increased carotid and intestinal, but not renal, arterial blood flows and oxygen delivery, whereas milrinone caused lower renal vascular resistance than epinephrine and dobutamine-treated groups. Plasma troponin I, plasma and myocardial lactate levels, and histologic ischemic features were not different among groups. In newborn piglets with hypoxia-reoxygenation, epinephrine, dobutamine and milrinone are effective inotropes to improve cardiac output, carotid and intestinal perfusion, without aggravating pulmonary hypertension. Milrinone may also improve renal perfusion.

Anesthetic efficacy of 1.8 mL versus 3.6 mL of 4% articaine with 1:100,000 epinephrine as a primary buccal infiltration of the mandibular first molar.

PubMed

Martin, Matthew; Nusstein, John; Drum, Melissa; Reader, Al; Beck, Mike

2011-05-01

No study has compared 1.8 mL and 3.6 mL 4% articaine with 1:100,000 epinephrine in a mandibular buccal infiltration of the first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 1.8 mL and 3.6 mL 4% articaine with 1:100,000 epinephrine as a primary infiltration in the mandibular first molar. Eighty-six asymptomatic adult subjects randomly received a primary mandibular buccal first molar infiltration of 1.8 mL or 3.6 mL 4% articaine with 1:100,000 epinephrine in two separate appointments. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 90 minutes after the injections. Compared with the 1.8-mL volume of 4% articaine with 1:100,000 epinephrine, the 3.6-mL volume showed a statistically higher success rate (70% vs 50%). The anesthetic efficacy of 3.6 mL 4% articaine with 1:100,000 epinephrine is better than 1.8 mL of the same anesthetic solution in a primary mandibular buccal infiltration of the first molar. However, the success rate of 70% is not high enough to support its use as a primary injection technique in the mandibular first molar. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A comparison between tourniquet application and epinephrine injection for hemostasis during hypospadias surgery: The effect on bleeding and postoperative outcome.

PubMed

Alizadeh, F; Fakoor, A; Haghdani, S

2016-06-01

To compare tourniquet application and epinephrine injection for hemostasis during hypospadias surgery in terms of bleeding and complications. Between April 2013 and September 2014, patients who were admitted for hypospadias repair were divided by random allocation into either a diluted epinephrine injection (DE) group or tourniquet application (T) group for hemostasis during the procedure. In the T group, a rubber band was applied at the base of the penis after skin dissection, and in the DE group, epinephrine 1/100,000 was injected along the incision lines. The patients' ages, urethral defect lengths, pre-operative, intraoperative and postoperative variables were compared between the two groups. A total of 70 patients (35 in each group) were enrolled into the study. The mean ages and preoperative variables were not significantly different. Average blood loss was 23.51 ± 15.36 cc in the tourniquet group and 15.99 ± 10.00 cc in the epinephrine group, and was significantly higher in tourniquet group (P = 0.022); however, the mean operative time was not significantly different. Postoperative complications, described as Clavian classification, were reported in eight patients (23%) in the T group and 10 patients (30%) in the DE group, which was not significantly different. Epinephrine injections minimize operative bleeding without significant harmful effects on postoperative outcomes; therefore, it could be considered to be a safe and effective method for preparation of a bloodless field during hypospadias surgery. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Should unobstructed gasping be facilitated and confirmed before administering adrenaline, otherwise, give titrated vasopressin?

PubMed

Rottenberg, Eric M

2015-02-01

A recent commentary, "Resuscitation That's (Un)Shockable: Time to Get the Adrenaline Flowing", published in the New England Journal of Medicine Journal Watch called attention to a relatively recent study showing that a large and increasing percentage of patients with in-hospital cardiac arrests exhibit initial nonshockable rhythms (asystole or pulseless electrical activity [PEA]; 82% in 2009 vs 69% in 2000) and a most recent study that concluded that neurologically intact survival to hospital discharge after in-hospital cardiac arrest was significantly more likely after earlier epinephrine administration. It was found that delayed administration of epinephrine was associated significantly with lower chance for survival to hospital discharge, in stepwise fashion (12%, 10%, 8%, and 7% survival, respectively, for patients receiving their first epinephrine dose≤3, 4-6, 7-9, and >9 minutes after arrest). Although early use of epinephrine to manage patients with nonshockable rhythms lacks strong evidence to support efficacy, focus on time to epinephrine administration-in addition to high-quality chest compressions-might be the best early intervention. However, evidence may strongly support the recommendation that adrenaline needs to be used very early because without effective-depth cardiopulmonary resuscitation (CPR) with complete recoil, epinephrine may only be effective when gasping is present, which is a time-limited phenomenon. However, because very few rescuers can perform effective-depth chest compressions with complete recoil, gasping is critically necessary for adequate ventilation and generation of adequate coronary and cerebral perfusion. However, under acidemic conditions and high catecholamine levels and/or absence of gasping, vasopressin should be administered instead. Published by Elsevier Inc.

Automated differential fluorometric analysis of norepinephrine and epinephrine in blood plasma and urine.

DOT National Transportation Integrated Search

1971-04-01

An automated fluorometric trihydroxyindole procedure is described for the measurement of norepinephrine (NE) and epinephrine (E) in blood plasma or urine. The method employs conventional techniques for isolation of the catecholamines by alumina colum...

Mechanism of early postradiation changes in intensity of spontaneous chemoluminescence of blood serum. [X rays; rats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baraboi, V.A.; Orel, V.E.; Sribnaya, A.F.

The effects of epinephrine and hydrocortisone on rat blood serum CL were tested under model conditions to analyze the possible role of biologically active compounds in the pathogenesis of the described postradiation changes. Injection of epinephrine in a concentration of 50 ..mu..g/kg, induced a rapid and substantial decline of CL followed by normalization. Addition of epinephrine directly to bovine blood serum in a model experiment, with access of atmospheric oxygen, caused progressive increase in CL with increase in dosage and exposure time. This experiment demonstrates the capacity of epinephrine to interact directly with oxygen, acting as a watersoluble antioxidant. Intraperitonealmore » injections of hydrocortisone revealed a marked decline of CL under these conditions. Direct addition of hydrocortisone to blood serum under model conditions did not affect its CL. Thus, the antioxidant effect of hydrocortisone is mediated in nature. The data indicate that postradiation increase in incretion of epinephrine and corticosteroids can explain the decrease in blood serum CL of rats exposed to lethal radiation. Since the reaction of the adrenosympathetic and adrenohypophyseal systems to total-body irradiation is a manifestation of a nonspecific stress reaction; the decreased intensity of blood serum CL is probably also a component of this reaction. (ERB)« less

Effect of lidocaine with and without epinephrine on lymphatic contractile activity in mice in vivo.

PubMed

Kwon, Sunkuk; Sevick-Muraca, Eva M

2016-12-01

A local anesthetic, lidocaine, is known to affect cutaneous blood flow when injected into the skin. However, it is unknown if dermal lymphatic function can also be affected. Therefore, we characterized lymphatic function in response to administration of lidocaine with and without epinephrine. Non-invasive near-infrared fluorescence imaging (NIRFI) with intradermal injection of indocyanine green (ICG) was used to characterize the lymphatic "pumping" function in mice after subcutaneous injection of 2 % lidocaine with and without 1:100,000 epinephrine or saline. NIRFI was performed for 10-20 min immediately after and 1, 3, and 5 h after these interventions. Lymphatic contraction frequencies significantly decreased 10 min after subcutaneous injection of lidocaine and remained plateaued for another 5 min, before returning to baseline. However, addition of 1:100,000 epinephrine to 2 % lidocaine rapidly increased lymphatic contraction frequencies at 5 min post-injection, which returned to baseline levels 15 min later. Injection of saline also increased lymphatic contraction frequency 5 min after injection, which returned to baseline 10 min post-injection. Although lidocaine administration showed a decrease in lymphatic function, the combination of epinephrine with lidocaine resulted in a predominant net effect of increased contractile activity.

Identifying Risk for Acute Kidney Injury in Infants and Children Following Cardiac Arrest.

PubMed

Neumayr, Tara M; Gill, Jeff; Fitzgerald, Julie C; Gazit, Avihu Z; Pineda, Jose A; Berg, Robert A; Dean, J Michael; Moler, Frank W; Doctor, Allan

2017-10-01

Our goal was to identify risk factors for acute kidney injury in children surviving cardiac arrest. Retrospective analysis of a public access dataset. Fifteen children's hospitals associated with the Pediatric Emergency Care Applied Research Network. Two hundred ninety-six subjects between 1 day and 18 years old who experienced in-hospital or out-of-hospital cardiac arrest between July 1, 2003, and December 31, 2004. None. Our primary outcome was development of acute kidney injury as defined by the Acute Kidney Injury Network criteria. An ordinal probit model was developed. We found six critical explanatory variables, including total number of epinephrine doses, postcardiac arrest blood pressure, arrest location, presence of a chronic lung condition, pH, and presence of an abnormal baseline creatinine. Total number of epinephrine doses received as well as rate of epinephrine dosing impacted acute kidney injury risk and severity of acute kidney injury. This study is the first to identify risk factors for acute kidney injury in children after cardiac arrest. Our findings regarding the impact of epinephrine dosing are of particular interest and suggest potential for epinephrine toxicity with regard to acute kidney injury. The ability to identify and potentially modify risk factors for acute kidney injury after cardiac arrest may lead to improved morbidity and mortality in this population.

Endocrine-disrupting effects of nonylphenol in the newt, Triturus carnifex (Amphibia, Urodela).

PubMed

Capaldo, Anna; Gay, Flaminia; Valiante, Salvatore; De Falco, Maria; Sciarrillo, Rosaria; Maddaloni, Massimo; Laforgia, Vincenza

2012-03-01

The aim of our study was to verify whether environmental concentrations of nonylphenol influenced the adrenal gland of Triturus carnifex. Newts were exposed to 19 μg/L nominal concentration of nonylphenol throughout the periods of December-January and March-April, corresponding to different stages of the chromaffin cell functional cycle. The morphological features of the steroidogenic and chromaffin tissues, and the serum levels of ACTH, aldosterone, corticosterone, norepinephrine and epinephrine were evaluated. Nonylphenol did not influence ACTH serum levels. During the two periods examined, the steroidogenic tissue had the same reaction: the quantity of cytoplasmic lipids, and the corticosteroid serum levels, decreased, suggesting the inhibition of synthesis and release of corticosteroids. During the two periods examined, the chromaffin tissue reacted differently to nonylphenol. During December-January, the numeric ratio of norepinephrine granules to epinephrine granules, and the epinephrine serum levels, increased, suggesting the stimulation of epinephrine release. During March-April, the numeric ratio of norepinephrine granules to epinephrine granules did not change, and the norepinephrine serum levels decreased, suggesting the inhibition of norepinephrine release. Our results show that nonylphenol influences the activity of the newt adrenal gland; considering the physiological role of this gland, our results suggest that nonylphenol may contribute to amphibian decline. Copyright © 2011. Published by Elsevier Inc.

Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: a randomized clinical trial.

PubMed

Mentzelopoulos, Spyros D; Malachias, Sotirios; Chamos, Christos; Konstantopoulos, Demetrios; Ntaidou, Theodora; Papastylianou, Androula; Kolliantzaki, Iosifinia; Theodoridi, Maria; Ischaki, Helen; Makris, Dimosthemis; Zakynthinos, Epaminondas; Zintzaras, Elias; Sourlas, Sotirios; Aloizos, Stavros; Zakynthinos, Spyros G

2013-07-17

Among patients with cardiac arrest, preliminary data have shown improved return of spontaneous circulation and survival to hospital discharge with the vasopressin-steroids-epinephrine (VSE) combination. To determine whether combined vasopressin-epinephrine during cardiopulmonary resuscitation (CPR) and corticosteroid supplementation during and after CPR improve survival to hospital discharge with a Cerebral Performance Category (CPC) score of 1 or 2 in vasopressor-requiring, in-hospital cardiac arrest. Randomized, double-blind, placebo-controlled, parallel-group trial performed from September 1, 2008, to October 1, 2010, in 3 Greek tertiary care centers (2400 beds) with 268 consecutive patients with cardiac arrest requiring epinephrine according to resuscitation guidelines (from 364 patients assessed for eligibility). Patients received either vasopressin (20 IU/CPR cycle) plus epinephrine (1 mg/CPR cycle; cycle duration approximately 3 minutes) (VSE group, n = 130) or saline placebo plus epinephrine (1 mg/CPR cycle; cycle duration approximately 3 minutes) (control group, n = 138) for the first 5 CPR cycles after randomization, followed by additional epinephrine if needed. During the first CPR cycle after randomization, patients in the VSE group received methylprednisolone (40 mg) and patients in the control group received saline placebo. Shock after resuscitation was treated with stress-dose hydrocortisone (300 mg daily for 7 days maximum and gradual taper) (VSE group, n = 76) or saline placebo (control group, n = 73). Return of spontaneous circulation (ROSC) for 20 minutes or longer and survival to hospital discharge with a CPC score of 1 or 2. Follow-up was completed in all resuscitated patients. Patients in the VSE group vs patients in the control group had higher probability for ROSC of 20 minutes or longer (109/130 [83.9%] vs 91/138 [65.9%]; odds ratio [OR], 2.98; 95% CI, 1.39-6.40; P = .005) and survival to hospital discharge with CPC score of 1 or 2 (18/130 [13.9%] vs 7/138 [5.1%]; OR, 3.28; 95% CI, 1.17-9.20; P = .02). Patients in the VSE group with postresuscitation shock vs corresponding patients in the control group had higher probability for survival to hospital discharge with CPC scores of 1 or 2 (16/76 [21.1%] vs 6/73 [8.2%]; OR, 3.74; 95% CI, 1.20-11.62; P = .02), improved hemodynamics and central venous oxygen saturation, and less organ dysfunction. Adverse event rates were similar in the 2 groups. Among patients with cardiac arrest requiring vasopressors, combined vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydrocortisone in postresuscitation shock, compared with epinephrine/saline placebo, resulted in improved survival to hospital discharge with favorable neurological status. clinicaltrials.gov Identifier: NCT00729794.

Anaesthetic efficacy of bupivacaine 2-hydroxypropyl-β-cyclodextrin for dental anaesthesia after inferior alveolar nerve block in rats.

PubMed

Serpe, L; Franz-Montan, M; Santos, C P dos; Silva, C B da; Nolasco, F P; Caldas, C S; Volpato, M C; Paula, E de; Groppo, F C

2014-05-01

Bupivacaine is a long-acting local anaesthetic that is widely used in medicine and dentistry. The duration and intensity of its sensory blockade in animal models is increased by its inclusion in complexes with cyclodextrins. The aim of the present study was to evaluate the anaesthetic efficacy of bupivacaine 2-hydroxypropyl-β-cyclodextrin (HPβCD) inclusion complex for dental anaesthesia after inferior alveolar nerve block in rats. Thirty rats were each given an injection close to the mandibular foramen of 0.2ml of one of the following formulations: 0.5% bupivacaine alone; 0.5% bupivacaine with 1:200,000 epinephrine; and 0.5% bupivacaine-HPβCD inclusion complex (bupivacaine-HPβCD). The other sides were used as controls, with either 0.9% saline or anaesthetic-free HPβCD solution being injected. The onset, success, and duration of pulpal anaesthesia were assessed by electrical stimulation ("pulp tester") on inferior molars. Results were analysed using ANOVA (Tukey), log rank, and chi square tests (α=5%). There were no differences among the formulations in onset of anaesthesia (p=0.59) or between the bupivacaine plus epinephrine and bupivacaine plus HPβCD in duration of anaesthesia, but bupivacaine plus epinephrine gave significantly higher values than bupivacaine alone (p=0.007). Bupivacaine plus epinephrine was a better anaesthetic than bupivacaine alone (p=0.02), while Bupi-HPβCD gave intermediate results, and therefore did not differ significantly from the other 2 groups (p=0.18 with bupivacaine alone; and p=0.44 with bupivacaine plus epinephrine). The bupivacaine-HPβCD complex showed similar anaesthetic properties to those of bupivacaine with epinephrine. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparative Evaluation of Anesthetic Efficacy of 2% Lidocaine, 4% Articaine, and 0.5% Bupivacaine on Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial.

PubMed

Aggarwal, Vivek; Singla, Mamta; Miglani, Sanjay

2017-01-01

To compare the anesthetic efficacy of 1.8 mL of 2% lidocaine with 1:200,000 epinephrine, 4% articaine with 1:100,000 epinephrine, and 0.5% bupivacaine with 1:200,000 epinephrine on producing inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. A total of 91 adult patients who were actively experiencing mandibular molar pain were involved in this study. The patients were randomly divided into three groups on the basis of the anesthetic solution used. The first group received IANB with 1.8 mL of 2% lidocaine with 1:200,000 epinephrine, the second group received IANB with 4% articaine with 1:100,000 epinephrine, and the third group received IANB with 0.5% bupivacaine with 1:200,000 epinephrine. After 15 minutes of IANB, conventional endodontic access preparation was started. The pain during the treatment was noted on a Heft-Parker visual analog scale (HP VAS). The primary outcome measure was anesthetic success, and anesthesia was considered successful if the patient reported no pain or weak/mild pain (HP VAS score < 55 mm) during endodontic treatment (pulp access and canal preparation procedures). The data were analyzed with one-way analysis of variance and chi-square test. The anesthetic success rates of 2% lidocaine, 4% articaine, and 0.5% bupivacaine were 23%, 33%, and 17%, respectively. The differences were statistically insignificant (P > .05). The 2% lidocaine solution used for IANB had similar success rates when compared with 4% articaine and 0.5% bupivacaine.

Nebulized hypertonic-saline vs epinephrine for bronchiolitis; proof of concept study of cumulative sum (CUSUM) analysis.

PubMed

Gupta, Neeraj; Puliyel, Ashish; Manchanda, Ayush; Puliyel, Jacob

2012-07-01

To apply cumulative sum (CUSUM) to monitor a drug trial of nebulized hypertonic-saline in bronchiolitis. To test if monitoring with CUSUM control lines is practical and useful as a prompt to stop the drug trial early, if the study drug performs significantly worse than the comparator drug. Prospective, open label, controlled trial using standard therapy (epinephrine) and study drug (hypertonic-saline) sequentially in two groups of patients. Hospital offering tertiary-level pediatric care. Children, 2 months to 2 years, with first episode of bronchiolitis, excluding those with cardiac disease, immunodeficiency and critical illness at presentation. Nebulized epinephrine in first half of the bronchiolitis season (n = 35) and hypertonic saline subsequently (n = 29). Continuous monitoring of response to hypertonic-saline using CUSUM control charts developed with epinephrine-response data. Clinical score, tachycardia and total duration of hospital stay. In the epinephrine group, the maximum CUSUM was +2.25 (SD 1.34) and minimum CUSUM was -2.26 (SD 1.34). CUSUM score with hypertonic saline group stayed above the zero line throughout the study. There was no statistical difference in the post-treatment clinical score at 24 hours between the treatment groups {Mean (SD) 3.516 (2.816): 3.552 (2.686); 95% CI: -1.416 to 1.356}, heart rate {Mean (SD) 136 (44): 137(12); 95% CI: -17.849 to 15.849) or duration of hospital stay (Mean (SD) 96.029 (111.41): 82.914 (65.940); 95% CI: -33.888 to 60.128}. The software we developed allows for drawing of control lines to monitor study drug performance. Hypertonic saline performed as well or better than nebulized epinephrine in bronchiolitis.

Impact of school peanut-free policies on epinephrine administration.

PubMed

Bartnikas, Lisa M; Huffaker, Michelle F; Sheehan, William J; Kanchongkittiphon, Watcharoot; Petty, Carter R; Leibowitz, Robert; Hauptman, Marissa; Young, Michael C; Phipatanakul, Wanda

2017-08-01

Children with food allergies spend a large proportion of time in school but characteristics of allergic reactions in schools are not well studied. Some schools self-designate as peanut-free or have peanut-free areas, but the impact of policies on clinical outcomes has not been evaluated. We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools. In this retrospective study, we analyzed (1) rates of epinephrine administration in all Massachusetts public schools and (2) Massachusetts public school nurse survey reports of school peanut-free policies from 2006 to 2011 and whether schools self-designated as "peanut-free" based on policies. Rates of epinephrine administration were compared for schools with or without peanut-restrictive policies. The percentage of schools with peanut-restrictive policies did not change significantly in the study time frame. There was variability in policies used by schools self-designated as peanut-free. No policy was associated with complete absence of allergic reactions. Both self-designated peanut-free schools and schools banning peanuts from being served in school or brought from home reported allergic reactions to nuts. Policies restricting peanuts from home, served in schools, or having peanut-free classrooms did not affect epinephrine administration rates. Schools with peanut-free tables, compared to without, had lower rates of epinephrine administration (incidence rate per 10,000 students 0.2 and 0.6, respectively, P = .009). These data provide a basis for evidence-based school policies for children with food allergies. Further studies are required before decisions can be made regarding peanut-free policies in schools. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions.

PubMed

Fernández-Cossío, Sergio; Rodríguez-Dintén, María Jesús; Gude, Francisco; Fernández-Álvarez, José Manuel

2016-10-01

The use of topical vasoconstrictors is a common practice in nasal surgery. These agents reduce bleeding and enable a good surgical field. Topical cocaine and epinephrine, which are frequently used in cosmetic rhinoplasty, are considered safe and effective, but secondary effects have been described. The aim of the present study was to evaluate and compare the benefits and risks of epinephrine and cocaine employed as topical vasoconstrictive agents in cosmetic rhinoplasty. This prospective non-randomised study included 65 consecutive female patients undergoing primary closed rhinoplasty. Patients were treated with topical aqueous solutions of 4 % cocaine (n = 33) or 1:1000 epinephrine (n = 32). Benefits and risks of drug use were compared between groups. Vasoconstriction was assessed by quantitative and qualitative evaluation of bleeding during surgery. Systemic effects were studied in terms of cardiovascular changes during the procedure. The Mann-Whitney test and mixed-effects models were used to compare continuous variables and to assess the effects of vasoconstrictor treatment, respectively. Cocaine exerted a stronger and more predictable vasoconstrictive effect than epinephrine. This difference was linked to better field quality, but did not relate to shorter surgery times. Increased heart rate was detected with both agents and was significantly higher with cocaine (p < 0.05). Blood pressure did not significantly differ between groups. Both cocaine and epinephrine, at the concentrations used in this study, are suitable as topical vasoconstrictive agents in aesthetic rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.

PubMed

Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Hasegawa, Manabu

2018-01-01

The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed. Outcome measures were survival and minimal neurological impairment [cerebral performance category (CPC) 1 or 2] at 1month after the event. We analyzed 37,873 cases that met the inclusion criteria. Among propensity-matched patients, advanced airway management and/or prehospital epinephrine use was related to decreased rates of 1-month survival (adjusted odds ratio 0.88, 95% confidence interval 0.80 to 0.97) and CPC (1, 2) (adjusted odds ratio 0.56, 95% confidence interval 0.48 to 0.66). Advanced airway management was related to decreased rates of 1-month survival (adjusted odds ratio 0.89, 95% confidence interval 0.81to 0.98) and CPC (1, 2) (adjusted odds ratio 0.54, 95% confidence interval 0.46 to 0.64) in patients who did not receive epinephrine, whereas epinephrine use was not related to the outcome measures. In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited. Copyright © 2017 Elsevier Inc. All rights reserved.

THE EFFECT OF ADRENAL MEDULLECTOMY ON METABOLIC RESPONSES TO CHRONIC INTERMITTENT HYPOXIA

PubMed Central

Shin, Mi-Kyung; Han, Woobum; Bevans-Fonti, Shannon; Jun, Jonathan C.; Punjabi, Naresh M.; Polotsky, Vsevolod Y.

2014-01-01

Obstructive sleep apnea causes intermittent hypoxia (IH) and is associated with insulin resistance and type 2 diabetes. IH increases plasma catecholamine levels, which may increase insulin resistance and suppress insulin secretion. The objective of this study was to determine if adrenal medullectomy (MED) prevents metabolic dysfunction in IH. MED or sham surgery was performed in 60 male C57BL/6J mice, which were then exposed to IH or control conditions (intermittent air) for 6 weeks. IH increased plasma epinephrine and norepinephrine levels, increased fasting blood glucose and lowered basal and glucose-stimulated insulin secretion. MED decreased baseline epinephrine and prevented the IH induced increase in epinephrine, whereas the norepinephrine response remained intact. MED improved glucose tolerance in mice exposed to IH, attenuated the impairment in basal and glucose-stimulated insulin secretion, but did not prevent IH-induced fasting hyperglycemia or insulin resistance. We conclude that the epinephrine release from the adrenal medulla during IH suppresses insulin secretion causing hyperglycemia. PMID:25179887

Voluntary Running Suppresses Tumor Growth through Epinephrine- and IL-6-Dependent NK Cell Mobilization and Redistribution.

PubMed

Pedersen, Line; Idorn, Manja; Olofsson, Gitte H; Lauenborg, Britt; Nookaew, Intawat; Hansen, Rasmus Hvass; Johannesen, Helle Hjorth; Becker, Jürgen C; Pedersen, Katrine S; Dethlefsen, Christine; Nielsen, Jens; Gehl, Julie; Pedersen, Bente K; Thor Straten, Per; Hojman, Pernille

2016-03-08

Regular exercise reduces the risk of cancer and disease recurrence. Yet the mechanisms behind this protection remain to be elucidated. In this study, tumor-bearing mice randomized to voluntary wheel running showed over 60% reduction in tumor incidence and growth across five different tumor models. Microarray analysis revealed training-induced upregulation of pathways associated with immune function. NK cell infiltration was significantly increased in tumors from running mice, whereas depletion of NK cells enhanced tumor growth and blunted the beneficial effects of exercise. Mechanistic analyses showed that NK cells were mobilized by epinephrine, and blockade of β-adrenergic signaling blunted training-dependent tumor inhibition. Moreover, epinephrine induced a selective mobilization of IL-6-sensitive NK cells, and IL-6-blocking antibodies blunted training-induced tumor suppression, intratumoral NK cell infiltration, and NK cell activation. Together, these results link exercise, epinephrine, and IL-6 to NK cell mobilization and redistribution, and ultimately to control of tumor growth. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of chemical cues on larval survival, settlement and metamorphosis of abalone Haliotis asinina

NASA Astrophysics Data System (ADS)

Wang, Xiaobing; Bai, Yang; Huang, Bo

2010-11-01

Low larval survival, poor settlement, and abnormal metamorphosis are major problems in seed production of donkey-ear abalone Haliotis asinina. We examined the effects of chemical cues including epinephrine, nor-epinephrine, and serotonin on larval survival, settlement, and metamorphosis in order to determine the possibility of using these chemicals to induce the problems. The results show that epinephrine could enhance metamorphosis rate at 10-6 mol/L only but higher concentrations (10-3-10-4 mol/L); and nor-epinephrine could inhibit the performance significantly, and serotonin could increase significantly the performance at a wide-range concentration (10-3-10-6 mol/L). Treatment with serotonin at 10-5 mol/L for 72 hours resulted in the highest settlement rate (42.2%) and survival rate (49.3%), while at 10-4 mol/L for 72 hours resulted in the highest metamorphosis rate (38.8%). Therefore, serotonin may be used as a fast metamorphosis inducer in abalone culture.

Inhibition of cyclooxygenase-independent platelet aggregation by sodium salicylate.

PubMed

Violi, F; Alessandri, C; Praticò, D; Guzzo, A; Ghiselli, A; Balsano, F

1989-06-15

The effect of acetylsalicylic acid (ASA) on platelet aggregation (PA) and thromboxane A2 (TxA2) formation was investigated in vitro and ex vivo after 1 g or 300 mg ASA administration to healthy subjects. 50-100 microM ASA inhibited PA by single aggregating agent such as platelet aggregating factor (PAF) or epinephrine and reduced to less than or equal to 5% of control platelet TxB2 formation, but did not influence PA by epinephrine plus PAF. The latter was inhibited by increasing ASA concentration. In samples incubated with 100 microM ASA and stimulated with epinephrine plus PAF, PA could be inhibited by the addition of 100-300 microM sodium salicylate. After 300 mg-1 g ASA administration to healthy subjects, the inhibition of PA by epinephrine plus PAF was more marked by highest doses of ASA. This study suggests that aspirin inhibits PA with a cyclooxygenase-independent mechanism; this effect is mediated, at least in vitro, by salicylic acid.

Lidocaine Concentration in Oral Tissue by the Addition of Epinephrine

PubMed Central

Tanaka, Eri; Yoshida, Kenji; Kawaai, Hiroyoshi; Yamazaki, Shinya

2016-01-01

The vasoconstrictive effect due to the addition of epinephrine to local anesthetic has been clearly shown by measuring blood-flow volume or blood anesthetic concentration in oral mucosal tissue. However, there are no reports on the measurement of anesthetic concentration using samples directly taken from the jawbone and oral mucosal tissue. Consequently, in this study, the effect of lidocaine concentration in the jawbone and oral mucosal tissue by the addition of epinephrine to the local anesthetic lidocaine was considered by quantitatively measuring lidocaine concentration within the tissue. Japanese white male rabbits (n = 96) were used as test animals. General anesthesia was induced by sevoflurane and oxygen, and then cannulation to the femoral artery was performed while arterial pressure was constantly recorded. Infiltration anesthesia was achieved by 0.5 mL of 2% lidocaine containing 1 : 80,000 epinephrine in the upper jawbone (E+) and 0.5 mL of 2% of epinephrine additive–free lidocaine (E0) under the periosteum. At specified time increments (10, 20, 30, 40, 50, and 60 minutes), samples from the jawbone, oral mucosa, and blood were collected, and lidocaine concentration was directly measured by high-performance liquid chromatography. No significant differences in the change in blood pressure were observed either in E+ or E0. In both E+ and E0 groups, the serum lidocaine concentration peaked 10 minutes after local anesthesia and decreased thereafter. At all time increments, serum lidocaine concentration in E+ was significantly lower than that in E0. There were no significant differences in measured lidocaine concentration between jawbone and mucosa within either the E+ or the E0 groups at all time points, although the E0 group had significantly lower jawbone and mucosa concentrations than the E+ group at all time points when comparing the 2 groups to each other. Addition of epinephrine to the local anesthetic inhibited systemic absorption of local anesthetic into the blood such that a high concentration could be maintained in the tissue. Epinephrine-induced vasoconstrictive effect was observed not only in the oral mucosa but also in the jawbone. PMID:26866407

Lidocaine Concentration in Oral Tissue by the Addition of Epinephrine.

PubMed

Tanaka, Eri; Yoshida, Kenji; Kawaai, Hiroyoshi; Yamazaki, Shinya

2016-01-01

The vasoconstrictive effect due to the addition of epinephrine to local anesthetic has been clearly shown by measuring blood-flow volume or blood anesthetic concentration in oral mucosal tissue. However, there are no reports on the measurement of anesthetic concentration using samples directly taken from the jawbone and oral mucosal tissue. Consequently, in this study, the effect of lidocaine concentration in the jawbone and oral mucosal tissue by the addition of epinephrine to the local anesthetic lidocaine was considered by quantitatively measuring lidocaine concentration within the tissue. Japanese white male rabbits (n = 96) were used as test animals. General anesthesia was induced by sevoflurane and oxygen, and then cannulation to the femoral artery was performed while arterial pressure was constantly recorded. Infiltration anesthesia was achieved by 0.5 mL of 2% lidocaine containing 1 : 80,000 epinephrine in the upper jawbone (E(+)) and 0.5 mL of 2% of epinephrine additive-free lidocaine (E(0)) under the periosteum. At specified time increments (10, 20, 30, 40, 50, and 60 minutes), samples from the jawbone, oral mucosa, and blood were collected, and lidocaine concentration was directly measured by high-performance liquid chromatography. No significant differences in the change in blood pressure were observed either in E(+) or E(0). In both E(+) and E(0) groups, the serum lidocaine concentration peaked 10 minutes after local anesthesia and decreased thereafter. At all time increments, serum lidocaine concentration in E(+) was significantly lower than that in E(0). There were no significant differences in measured lidocaine concentration between jawbone and mucosa within either the E(+) or the E(0) groups at all time points, although the E(0) group had significantly lower jawbone and mucosa concentrations than the E(+) group at all time points when comparing the 2 groups to each other. Addition of epinephrine to the local anesthetic inhibited systemic absorption of local anesthetic into the blood such that a high concentration could be maintained in the tissue. Epinephrine-induced vasoconstrictive effect was observed not only in the oral mucosa but also in the jawbone.

Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock.

PubMed

Ventura, Andréa M C; Shieh, Huei Hsin; Bousso, Albert; Góes, Patrícia F; de Cássia F O Fernandes, Iracema; de Souza, Daniela C; Paulo, Rodrigo Locatelli Pedro; Chagas, Fabiana; Gilio, Alfredo E

2015-11-01

The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare-associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. Double-blind, prospective, randomized controlled trial from February 1, 2009, to July 31, 2013. PICU, Hospital Universitário da Universidade de São Paulo, Brazil. Consecutive children who are 1 month to 15 years old and met the clinical criteria for fluid-refractory septic shock. Exclusions were receiving vasoactive drug(s) prior to hospital admission, having known cardiac disease, having already participated in the trial during the same hospital stay, refusing to participate, or having do-not-resuscitate orders. Patients were randomly assigned to receive either dopamine (5-10 μg/kg/min) or epinephrine (0.1-0.3 μg/kg/min) through a peripheral or intraosseous line. Patients not reaching predefined stabilization criteria after the maximum dose were classified as treatment failure, at which point the attending physician gradually stopped the study drug and started another catecholamine. Physiologic and laboratory data were recorded. Baseline characteristics were described as proportions and mean (± SD) and compared using appropriate statistical tests. Multiple regression analysis was performed, and statistical significance was defined as a p value of less than 0.05. Baseline characteristics and therapeutic interventions for the 120 children enrolled (63, dopamine; 57, epinephrine) were similar. There were 17 deaths (14.2%): 13 (20.6%) in the dopamine group and four (7%) in the epinephrine group (p=0.033). Dopamine was associated with death (odds ratio, 6.5; 95% CI, 1.1-37.8; p=0.037) and healthcare-associated infection (odds ratio, 67.7; 95% CI, 5.0-910.8; p=0.001). The use of epinephrine was associated with a survival odds ratio of 6.49. Dopamine was associated with an increased risk of death and healthcare-associated infection. Early administration of peripheral or intraosseous epinephrine was associated with increased survival in this population. Limitations should be observed while interpreting these results.

Alpha 1 adrenergic receptor mediated polyphosphoinositide breakdown in DDT1-MF2 cells. Lack of evidence of desensitization after prolonged exposure to epinephrine.

PubMed

Rosenbaum, J S; Azhar, S; Hoffman, B B

1987-12-15

The DDT1-MF2 cell line is a transformed smooth muscle cell line which is known to possess both alpha 1 and beta 2 adrenergic receptors. We have utilized these cells to compare the effects of epinephrine pretreatment on the functional capabilities of these two different adrenergic receptors. Pretreatment of the cells grown in suspension with 10(-7) M epinephrine for 6 hr resulted in desensitization of beta receptor stimulated cyclic AMP accumulation. The maximal response to isoproterenol was decreased to 46 +/- 6% of the value in controls (P less than 0.05); there was also a decrease in the sensitivity of the cells to isoproterenol (log EC50 = -6.65 +/- 0.22 vs -7.26 +/- 0.11 in controls, P less than 0.05). Also, there was a decrease in the number of beta receptors from 257 +/- 29 to 163 +/- 22 fmol/mg protein. In contrast, pretreatment with 10(-6) M epinephrine for 6 hr failed to induce a loss of sensitivity in the ability of the alpha 1 receptor agonist phenylephrine to stimulate inositol triphosphate accumulation (log EC50 = -5.59 +/- 0.18 vs -5.42 +/- 0.44 in control cells). A 2-fold increase in basal inositol monophosphate accumulation was observed after epinephrine pretreatment (P less than 0.05); however, there was no change in maximal phenylephrine-stimulated inositol monophosphate accumulation in these cells. There was a small decrease in the alpha 1 receptor number after epinephrine pretreatment (Bmax = 457 +/- 89 fmol/mg protein vs 540 +/- 94 in control cells, P less than 0.05). In contrast to epinephrine pretreatment, pretreatment of cells in suspension with 10(-7) M 12-O-tetradecanoylphorbol-13-acetate (TPA) for 15 min resulted in a nearly complete blunting in the ability of both norepinephrine and phenylephrine to stimulate inositol phosphate accumulation: after norepinephrine stimulation, 774 +/- 34 dpm in TPA-pretreated cells vs 2590 +/- 10 in control cells; inositol monophosphate accumulation after phenylephrine stimulation 576 +/- 25 dpm in TPA-pretreated cells vs 1660 +/- 27 in control cells. Basal levels of inositol monophosphate remained unchanged at 544 +/- 28 dpm vs 505 +/- 31 in TPA-pretreated cells compared to control cells. These data indicate that protein kinase C may exert a negative feedback control on the alpha 1 receptor in these cells and that direct activation of protein kinase C by phorbol esters may have a different effect on the alpha 1 adrenergic receptor system in DDT1-MF2 cells than does prolonged exposure to epinephrine.

Distribution and absorption of local anesthetics in inferior alveolar nerve block: evaluation by magnetic resonance imaging.

PubMed

Ay, Sinan; Küçük, Dervisşhan; Gümüş, Cesur; Kara, M Isa

2011-11-01

The aim of this study was to evaluate the distribution and absorption of local anesthetic solutions in inferior alveolar nerve block using magnetic resonance imaging. Forty healthy volunteers were divided into 4 groups and injected with 1.5 mL for inferior alveolar nerve block and 0.3 mL for lingual nerve block. The solutions used for the different groups were 2% lidocaine, 2% lidocaine with 0.125 mg/mL epinephrine, 4% articaine with 0.006 mg/mL epinephrine, and 4% articaine with 0.012 mg/mL epinephrine. All subjects had axial T2-weighted and fat-suppressed images at 0, 60, and 120 minutes after injection. The localization, area, and intensity (signal characteristics) of the solutions were analyzed and onset and duration times of the anesthesia were recorded. There were no significant differences between groups with regard to the intensity and area of the solutions at 0, 60, and 120 minutes after injection, but differences were found within each group. No between-group differences were found on magnetic resonance imaging in the distribution and absorption of lidocaine with or without epinephrine and articaine with 0.006 and 0.012 mg/mL epinephrine. All solutions were noticeably absorbed at 120 minutes after injection. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Rapidly-disintegrating sublingual tablets of epinephrine: role of non-medicinal ingredients in formulation development.

PubMed

Rachid, Ousama; Rawas-Qalaji, Mutasem; Simons, F Estelle R; Simons, Keith J

2012-11-01

Epinephrine is the drug of choice in the management of anaphylaxis. For first-aid treatment in the community, epinephrine autoinjectors (E-autos) are commonly prescribed, but are underutilized. In our laboratory, we developed a series of first-generation rapidly-disintegrating sublingual tablets (RDSTs) containing 40mg of epinephrine. One RDST had similar bioavailability to epinephrine 0.3mg from an auto-injector, as confirmed in a validated rabbit model, while other formulations containing different non-medicinal ingredients (NMIs) and with similar in vitro characteristics demonstrated much lower bioavailability. Subsequently, we evaluated the effect of changing the grade and proportion of NMIs, specifically mannitol and microcrystalline cellulose (MCC), on the in vitro characteristics of second- and third-generation RDSTs. Weight variation, content uniformity, breaking force, and friability were tested using official USP methods. Novel validated methods that simulate ambient conditions of the sublingual cavity were developed to test disintegration time, wetting time, and dissolution. Using these methods, it was possible to measure the effects of making small changes in NMIs on the in vitro characteristics of the formulations. The RDST formulation that resulted in the best in vitro characteristics contained the optimum proportion of mannitol and a specific ratio of coarse and fine particle grades of MCC. Appropriate comparative testing resulted in the selection of the RDST with the optimum in vitro characteristics. Copyright © 2012 Elsevier B.V. All rights reserved.

Preparedness for Students and Staff with Anaphylaxis

ERIC Educational Resources Information Center

Morris, Patty; Baker, Dian; Belot, Carol; Edwards, Audrey

2011-01-01

Background: Schools are responsible for handling life-threatening events due to a variety of conditions, including anaphylaxis. California is one of a few states that permits school districts to stock emergency epinephrine auto-injectors and to train unlicensed assistive personnel to administer epinephrine for a life-threatening event. We surveyed…

Milk Allergy

MedlinePlus

... your doctor may want you to carry a shot of epinephrine (pronounced: eh-peh-NEH-frin) with you in case of an emergency. Epinephrine comes in an easy-to-carry container about the size of a large marker. It's easy to use — your ... — give yourself the shot right away to counteract the reaction while you' ...

Systemic effects of an intraosseous injection of 2% lidocaine with 1:100,000 epinephrine.

PubMed

Chamberlain, T M; Davis, R D; Murchison, D F; Hansen, S R; Richardson, B W

2000-01-01

The effect of a mandibular intraosseous injection of 2% lidocaine with 1:100,000 epinephrine on the heart rate and blood pressure of 20 volunteer patients was examined. Changes in blood pressure from preoperative levels were minimal and did not vary significantly at any time of measurement. The only statistically significant change in heart rate occurred immediately after the intraosseous injection (an increase of 12 beats per minute). In young healthy adults, the intraosseous injection of 1.5 mL of 2% lidocaine with 1:100,000 epinephrine resulted in a slight transient elevation in heart rate but had no significant effect on systolic or diastolic blood pressure.

Relationship between temperament and transportation with rectal temperature and secretion of cortisol and epinephrine in bulls

USDA-ARS?s Scientific Manuscript database

This study investigated whether temperament influences rectal temperature and the secretion of cortisol and epinephrine in response to transportation. Brahman bulls were selected based on temperament score (average of exit velocity, EV, and pen score, PS) measured 28 days prior to weaning with the 8...

Temperament influences endotoxin-induced changes in rectal temperature, sickness behavior, and plasma epinephrine concentrations in bulls

USDA-ARS?s Scientific Manuscript database

This study was designed to determine the influence of temperament on endotoxin (lipopolysaccharide; LPS) induced changes in body temperature and the secretion of cortisol and epinephrine. Purebred Brahman bulls were selected based on temperament score (average of exit velocity, EV, and pen score, PS...

Relationships Between Temperament and Transportation With Rectal Temperature and Serum Concentrations of Cortisol and Epinephrine in Bulls

USDA-ARS?s Scientific Manuscript database

This study investigated whether temperament influences rectal temperature and serum concentrations of cortisol and epinephrine in response to transportation. Brahman bulls were selected based on temperament score (average of exit velocity, EV, and pen score, PS) measured 28 days prior to weaning wit...

REGULATION OF MEMORY – FROM THE ADRENAL MEDULLA TO LIVER TO ASTROCYTES TO NEURONS1

PubMed Central

Gold, Paul E.

2014-01-01

Epinephrine, released into blood from the adrenal medulla in response to arousing experiences, is a potent enhancer of learning and memory processing. This review examines mechanisms by which epinephrine exerts its effects on these cognitive functions. Because epinephrine is largely blocked from moving from blood to brain, it is likely that the hormone's effects on memory are mediated by peripheral actions. A classic effect of epinephrine is to act at the liver to break down glycogen stores, resulting in increased blood glucose levels. The increase in blood glucose provides additional energy substrates to the brain to buttress the processes needed for an experience to be learned and remembered. In part, it appears that the increased glucose may act in the brain in a manner akin to that evident in the liver, engaging glycogenolysis in astrocytes to provide an energy substrate, in this case lactate, to augment neuronal functions. Together, the findings reveal a mechanism underlying modulation of memory that integrates the physiological functions of multiple organ systems to support brain processes. PMID:24406469

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

PubMed

Claffey, Elizabeth; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2004-08-01

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

Ventilation Strategies during Neonatal Cardiopulmonary Resuscitation

PubMed Central

Baik, Nariae; O’Reilly, Megan; Fray, Caroline; van Os, Sylvia; Cheung, Po-Yin; Schmölzer, Georg M.

2018-01-01

Approximately, 10–20% of newborns require breathing assistance at birth, which remains the cornerstone of neonatal resuscitation. Fortunately, the need for chest compression (CC) or medications in the delivery room (DR) is rare. About 0.1% of term infants and up to 15% of preterm infants receive these interventions, this will result in approximately one million newborn deaths annually worldwide. In addition, CC or medications (epinephrine) are more frequent in the preterm population (~15%) due to birth asphyxia. A recent study reported that only 6 per 10,000 infants received epinephrine in the DR. Further, the study reported that infants receiving epinephrine during resuscitation had a high incidence of mortality (41%) and short-term neurologic morbidity (57% hypoxic-ischemic encephalopathy and seizures). A recent review of newborns who received prolonged CC and epinephrine but had no signs of life at 10 min following birth noted 83% mortality, with 93% of survivors suffering moderate-to-severe disability. The poor prognosis associated with receiving CC alone or with medications in the DR raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. PMID:29484288

Epinephrine stimulation of anion secretion in the Calu-3 serous cell model

PubMed Central

Banga, Amiraj; Flaig, Stephanie; Lewis, Shanta; Winfree, Seth

2014-01-01

Calu-3 is a well-differentiated human bronchial cell line with the characteristics of the serous cells of airway submucosal glands. The submucosal glands play a major role in mucociliary clearance because they secrete electrolytes that facilitate airway hydration. Given the significance of both long- and short-term β-adrenergic receptor agonists in the treatment of respiratory diseases, it is important to determine the role of these receptors and their ligands in normal physiological function. The present studies were designed to characterize the effect of epinephrine, the naturally occurring β-adrenergic receptor agonist, on electrolyte transport of the airway serous cells. Interestingly, epinephrine stimulated two anion secretory channels, the cystic fibrosis transmembrane conductance regulator and a Ca2+-activated Cl− channel, with the characteristics of transmembrane protein 16A, thereby potentially altering mucociliary clearance via multiple channels. Consistent with the dual channel activation, epinephrine treatment resulted in increases in both intracellular cAMP and Ca2+. Furthermore, the present results extend previous reports indicating that the two anion channels are functionally linked. PMID:24705724

Intraosseous anaesthesia in children with 4 % articaine and epinephrine 1:400,000 using computer-assisted systems.

PubMed

Sixou, J-L; Marie-Cousin, A

2015-12-01

To assess retrospectively the efficacy of computer-assisted intraosseous anaesthesia (CAIO) in children using an anaesthetic solution with a lower concentration of epinephrine (1:400,000). In a retrospective study, CAIO was evaluated in healthy children and adolescents for restorative and endodontic treatments, uncomplicated tooth extractions or scalings using articaine 4 % plus epinephrine 1:400,000. Anaesthesia was performed in children who showed enough compliance (score of 0-3 according to modified behaviour Venham scale). Efficacy, amount of anaesthetic solution as well as need of a complementary injection was assessed. A total of 421 consecutive sessions were performed on 278 patients aged 7.1 ± 2.9 years with 518 teeth involved in the anaesthetic process and analysed process. When teeth to be anaesthetised were considered, the overall success rate was 97.2 %. In most of the cases, only 0.9 mL was needed to achieve anaesthesia. Permanent teeth needed significantly more anaesthetics than primary teeth. Sensitivity of the teeth anaesthetized reappeared in 5.7 % of cases after 30-60 min of treatment. These results suggest that CAIO with 4 % articaine and epinephrine diluted 1:400,000 can be an alternative to usual infiltration techniques or IO with epinephrine at a higher concentration for most of treatments in primary and permanent teeth. Further studies are needed to evaluate its efficacy in permanent teeth in case of endodontic treatment or extraction.

Anesthetic Efficacy of a Combination of 4% Prilocaine/2% Lidocaine with Epinephrine for the Inferior Alveolar Nerve Block: A Prospective, Randomized, Double-blind Study.

PubMed

Cook, Olivia; Nusstein, John; Drum, Melissa; Fowler, Sara; Reader, Al; Draper, John

2018-05-01

Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs). One hundred eighteen asymptomatic subjects were randomly given a combination of 1 cartridge of 4% prilocaine plain plus 1 cartridge of 2% lidocaine with 1:100,000 epinephrine or a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine for the IANB at 2 separate appointments. Subjects rated the pain associated with anesthetic solution deposition of injection. Mandibular teeth were tested with an electric pulp tester every 4 minutes for 57 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 17 minutes and the 80 reading was continuously sustained for 57 minutes. Comparisons for anesthetic success were analyzed using the exact McNemar test, and pain ratings associated with anesthetic solution deposition were analyzed using multiple Wilcoxon matched pairs signed rank tests; both were adjusted using the step-down Bonferroni method of Holm. Four percent prilocaine plain was significantly less painful upon anesthetic solution deposition. Pulpal anesthetic success was not significantly different between the 2 combinations. The combination of 4% prilocaine plain plus 2% lidocaine with 1:100,000 epinephrine did not increase pulpal anesthetic success for IANBs compared with a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine. Pain associated with anesthetic solution deposition from the first cartridge of 4% prilocaine plain was significantly less when compared with the first cartridge of 2% lidocaine with 1:100,000 epinephrine. Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of ascorbic acid and alpha tocopherol supplementation on acute restraint stress induced changes in testosterone, corticosterone and nor epinephrine levels in male Sprague Dawley rats.

PubMed

Lodhi, Ghulam Mustafa; Latif, Rabia; Hussain, Muhammad Mazhar; Naveed, Abdul Khaliq; Aslam, Muhammad

2014-01-01

Stress of various origins suppresses male reproductive functions through releasing stress hormones. Antioxidant like ascorbic acid (AA) and alpha tocopherol (AT) have been thought to protect the body against stress induced damage. Whether, these antioxidants confer protection against the stress induced increased levels of corticosterone and nor-epinephrine, and decreased testosterone secretion have been investigated in this study. This quasi experimental study was carried out at the Department of Physiology, Army Medical College Rawalpindi in collaboration with National Institute of Health, Islamabad during March to September 2009. Eighty male Sprague Dawley rats were divided into five groups with sixteen rats in each group. Group-I served as the control without stress while group-II was exposed to restraint stress for 6 hours, group-III was administered AA, group-IVAT and group-V was supplemented with both the antioxidants along with standard diet for one month. All antioxidant supplemented groups were exposed to restraint stress for 6 hours. Immediately after the stress episode, blood sample was obtained for the assay of serum testosterone, serum corticosterone by EIA and plasma nor-epinephrine levels by ELISA. Data were analyzed on SPSS-13 and p-value less than 0.05 was considered significant. Acute restraint stress resulted in a statistically significant rise in corticosterone and nor-epinephrine levels and fall in serum testosterone levels. AA supplementation for one month revealed insignificant changes in stress induced hormonal parameters. AT alone and in combination with ascorbic acid prevented the fall in testosterone level as well as rise in corticosterone, however nor-epinephrine levels remained unchanged. Supplementation with AT alone or in combination with AA prevent reduction in testosterone and rise in corticosterone levels while keeping the nor-epinephrine levels unchanged after acute restraint stress in Sprague Dawley rats.

Staining intraoperative topical solutions with fluorescein: enhancing the safety of sinus surgery.

PubMed

Yao, William C; Regone, Rachel M; Takashima, Masayoshi

2015-09-01

Oxymetazoline HCl 0.05%, 1:100,000 lidocaine with epinephrine (lido+epi), and 1:1000 epinephrine are all colorless solutions employed in sinus surgery. Because lido+epi is injected whereas others are not, care must be taken to label all solutions to avoid inadvertent injection of oxymetazoline or concentrated epinephrine because of life-threatening complications. Dyes have been used to color solutions for visual identification, but efficacy and cost have never been compared. We sought to determine the effectiveness of surgical marking pen (gentian violet) and fluorescein strips as coloring agents in mediums commonly used in sinus surgery. In this specialty techniques study, 4 liquid mediums (normal saline [NS], 0.05% oxymetazoline, 1:1,000 epinephrine, and lido+epi) and 2 coloring agents (fluorescein strip and surgical marking pen) were combined separately. Photos and absorbance of each solution were obtained at 15-minute intervals over 2 hours using a spectrophotometer. Peak absorbance remained stable for all solutions with fluorescein. Absorbance also remained constant for NS (0.37 absorbance units [AU] → 0.37 AU) and oxymetazoline (2.8 AU → 2.8 AU) mixed with marking pen. Absorbance decreased over 2 hours when marking pen was mixed with 1:1000 epinephrine (0.82 AU → 0.32 AU) and lido+epi (1.19 AU → 0.33 AU). Furthermore, the majority of color visibility and absorbance decreased in the first 15 minutes for concentrated epinephrine (0.82 → 0.33) and lido+epi (1.19 → 0.51). Cost of fluorescein strips ($0.14 to $0.20/strip) was less than marking pens ($13 to 46/pen). Compared to marking pen dye, solutions dyed with fluorescein retained their color and did not decay over time. We recommend fluorescein strips to label colorless materials in the operating room because of their lack of color decay and cost advantages. © 2015 ARS-AAOA, LLC.

Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†.

PubMed

Parascandola, Salvatore A; Ibañez, Jessica; Keir, Graham; Anderson, Jacqueline; Plankey, Michael; Flynn, Deanna; Cody, Candice; De Marchi, Lorenzo; Margolis, Marc; Blair Marshall, M

2017-06-01

The purpose of this research is to compare liposomal bupivacaine and bupivacaine/epinephrine for intercostal blocks related to analgesic use and length of stay following video-assisted thoracoscopic wedge resection. A retrospective study of patients undergoing video-assisted thoracoscopic wedge resection from 2010 to 2015 was performed. We selected patients who stayed longer than 24 h in hospital. Primary outcomes were length of stay and postoperative analgesic use at 12-h intervals from 24 to 72 h. Intercostal blocks were performed with liposomal bupivacaine in 62 patients and bupivacaine/epinephrine in 51 patients. A Wilcoxon signed-rank test evaluated differences in median postoperative analgesic use and length of stay. Those who received liposomal bupivacaine consumed fewer analgesics than those who received bupivacaine/epinephrine, with a statistically significant difference from 24 to 36 h (20.25 vs 45.0 mg; P  = 0.0059) and from 60 to 72 h postoperatively (15.0 vs 33.75 mg; P  = 0.0350). In patients who stayed longer than 72 h, the median cumulative analgesic consumption in those who received liposomal bupivacaine was statistically significantly lower than those who received bupivacaine/epinephrine (120.0 vs 296.5 mg; P  = 0.0414). Median length of stay for the liposomal bupivacaine and bupivacaine/epinephrine groups were 45:05 h and 44:29 h, respectively. There were no adverse events related to blocks performed with liposomal bupivacaine. Thoracic surgery patients who have blocks performed with liposomal bupivacaine require fewer analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

The relationship between magnesium, epinephrine and norepinephrine blood concentrations during CABG with normovolemic hemodilution.

PubMed

Pasternak, K; Dabrowski, W; Wyciszczok, T; Korycińska, A; Dobija, J; Biernacka, J; Rzecki, Z

2005-12-01

The effects of procedures with extracorporeal circulation on the disturbance of relationships between blood magnesium (Mg), epinephrine, and norepinephrine levels have not been explicitly explained. It is assumed that both hypomagnesemia and increased concentration of the above mentioned hormones exert adverse effects on the myocardium often causing life threatening disorders. This problem is particularly important in cases of stunned myocardium, observed after extracorporeal circulation procedures. The complex nature of the procedures and the intraoperative normovolemic hemodilution (NH) employed are likely to alter Mg, epinephrine, and norepinephrine concentrations, as well as the above mentioned relations. The aim of the study was to evaluate the changes in blood Mg, epinephrine and norepinephrine concentrations in patients undergoing extracorporeal circulation and normovolemic hemodilution. The study encompassed 16 men operated on for stable coronary disease (I or II degrees according to the Canadian Scale). The patients were divided into two groups according to body weight: A) patients weighing less than 75 kg and B) patients weighing more than 75 kg. The degree of NH caused by constant volume of priming (1800 mL) was determined on the basis of hematocrit measurements and in relation to body weight. The examinations were conducted in 5 stages: 1) after radial artery cannulation before anaesthesia and surgery, 2) during hemodilution and deepest hypothermia, 3) after surgery before sending the patient to Intensive Postoperative care Unit, 4) in the first postoperative day, 5) in the second postoperative day. The observations showed an increase in epinephrine levels in group A in the second stage and of norepinephrine levels in stage 4. Decreased blood Mg levels were noted in all the patients in the second stage, however in group A significantly lower values were also observed in stage 3. Moreover, the correlation between Mg level changes and blood epinephrine and norepinephrine levels were observed. The study revealed significant effects of extracorporeal circulation procedures on adrenergic reactions as well as blood magnesium concentrations. It seems that the degree of NH is the main factor determining blood levels of Mg, epinephrine and norepinephrine during the use of a heart-lung apparatus, which may be particularly relevant in patients with impaired heart function and low body weight.

Low-Dose Epinephrine Plus Tranexamic Acid Reduces Early Postoperative Blood Loss and Inflammatory Response: A Randomized Controlled Trial.

PubMed

Zeng, Wei-Nan; Liu, Jun-Li; Wang, Fu-You; Chen, Cheng; Zhou, Qiang; Yang, Liu

2018-02-21

The reductions of perioperative blood loss and inflammatory response are important in total knee arthroplasty. Tranexamic acid reduced blood loss and the inflammatory response in several studies. However, the effect of epinephrine administration plus tranexamic acid has not been intensively investigated, to our knowledge. In this study, we evaluated whether the combined administration of low-dose epinephrine plus tranexamic acid reduced perioperative blood loss or inflammatory response further compared with tranexamic acid alone. This randomized placebo-controlled trial consisted of 179 consecutive patients who underwent primary total knee arthroplasty. Patients were randomized into 3 interventions: Group IV received intravenous low-dose epinephrine plus tranexamic acid, Group TP received topical diluted epinephrine plus tranexamic acid, and Group CT received tranexamic acid alone. The primary outcome was perioperative blood loss on postoperative day 1. Secondary outcomes included perioperative blood loss on postoperative day 3, coagulation and fibrinolysis parameters (measured by thromboelastography), inflammatory cytokine levels, transfusion values (rate and volume), thromboembolic complications, length of hospital stay, wound score, range of motion, and Hospital for Special Surgery (HSS) score. The mean calculated total blood loss (and standard deviation) in Group IV was 348.1 ± 158.2 mL on postoperative day 1 and 458.0 ± 183.4 mL on postoperative day 3, which were significantly reduced (p < 0.05) compared with Group TP at 420.5 ± 188.4 mL on postoperative day 1 and 531.1 ± 231.4 mL on postoperative day 3 and Group CT at 520.4 ± 228.4 mL on postoperative day 1 and 633.7 ± 237.3 mL on postoperative day 3. Intravenous low-dose epinephrine exhibited a net anti-inflammatory activity in total knee arthroplasty and did not induce an obvious hypercoagulable status. Transfusion values were significantly reduced (p < 0.05) in Group IV, but no significant differences were observed in the incidence of thromboembolic complications, wound score, range of motion, and HSS score among the 3 groups (p > 0.05). The combined administration of low-dose epinephrine and tranexamic acid demonstrated an increased effect in reducing perioperative blood loss and the inflammatory response compared with tranexamic acid alone, with no apparent increased incidence of thromboembolic and other complications. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The effect of local compression and topical epinephrine on perioperative bleeding and degree of urinary extravasation on postoperative cystogram following radical retropubic prostatectomy.

PubMed

Malik, Rena; Laze, Juliana; Lepor, Herbert

2010-08-01

To evaluate the efficacy of local compression and topical epinephrine in controlling perioperative bleeding during open radical retropubic prostatectomy (ORRP) and its impact on the degree of urinary extravasation on initial postoperative cystogram. Between September 2005 to March 2009, 476 men underwent ORRP performed by a single surgeon. Group 1 (n = 200) underwent ORRP between September 2005 and November 2006 without pelvic compression; Group 2 (n = 76) underwent ORRP between November 2006 and May 2007 and a dry laparotomy pad was positioned in the pelvis immediately prior to abdominal wound closure; Group 3 (n = 200) underwent ORRP between May 2007 and March 2009 with a epinephrine soaked laparotomy pad positioned in the pelvis prior to abdominal wound closure. Hematocrit values were obtained prior to anesthesia induction, upon arrival in the recovery room and at hospital discharge in order to estimate intraoperative and postoperative bleeding. The number of allogenic and autologous units transfused was recorded. The utility of compressing the pelvis with a pad was examined by comparing estimated postoperative bleeding between Group 1 versus Groups 2 and 3 and the hemostatic utility of soaking the pad in epinephrine was examined by comparing Group 2 versus 3. Systolic and diastolic blood pressure and pulse measurements were obtained at baseline and 5 and 10 minutes after introducing the epinephrine pad. The relationship between estimated blood loss and degree of extravasation on initial postoperative cystogram was investigated. Estimated intraoperative, postoperative and total blood loss (mean change in Hct) was 12.2, 2.3, 14.2, in Group 1, 10.0, 1.5, 11.1 in Group 2, and 10.8, 2.1, and 12.6 in Group 3. Estimated intraoperative and total blood loss was significantly less in the men treated with a compression pad (Groups 2 and 3) versus no pad (Group 1). There were no significant differences in number of patients transfused, the number of units transfused or the degree of extravasation on postoperative cystograms between Group 1 versus Group 2 and 3 or Group 2 versus 3. However, postoperative bleeding was significantly less in Group 2 compared to Group 3. Mean systolic and diastolic blood pressure and pulse values were unchanged from baseline after epinephrine use. Local compression of the pelvis with or without epinephrine prior to abdominal wound closure does not appear to have beneficial effects on reducing postoperative bleeding and decreasing the degree of urinary extravasation on cystogram following ORRP. While the use of topical epinephrine appears to be safe and relatively inexpensive, at the concentrations used in our study it does not appear to facilitate postoperative hemostasis.

The influence of temperament on endotoxin-induced changes in body temperature, sickness behavior, and secretion of cortisol and epinephrine in bulls

USDA-ARS?s Scientific Manuscript database

This study was designed to determine the influence of temperament on body temperature, sickness behavior, and the secretion of cortisol and epinephrine in response to an endotoxin challenge. Purebred Brahman bulls were selected based on temperament score measured at weaning [n=8 each Calm (C), Inter...

Intrapleural Epinephrine Irrigation for Massive Malignant Hemothorax.

PubMed

Huang, Pei-Ming; Chou, Nai-Kuan; Lin, Tzu-Hsin; Chen, Chiung-Nien

2016-04-01

Massive malignant hemothorax (MMH) is a rare and serious complication encountered in the field of oncology and can be life threatening. It is often difficult and complex to manage. Herein, we present cases of four patients who had MMH and in whom a hemothorax was successfully stopped via continuous intrapleural irrigation with epinephrine (5-mg epinephrine/1,000-mL normal saline, infused at 100 mL/h) instead of a conventional surgical approach. Although no patient deaths were attributed to intractable bleeding, two deaths were related to multiple organ failure. Despite the limited number of cases, this method was a convenient, effective, and inexpensive alternative to open surgical or thoracoscopic drainage for MMH. Georg Thieme Verlag KG Stuttgart · New York.

Comparison of the anaesthetic efficacy of epinephrine concentrations (1 : 80 000 and 1 : 200 000) in 2% lidocaine for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized, double-blind clinical trial.

PubMed

Aggarwal, V; Singla, M; Miglani, S; Kohli, S

2014-04-01

The aim of this randomized controlled, double-blind trial was to comparatively evaluate the anaesthetic efficacy and injection pain of 1.8 mL of 2% lidocaine with different concentrations of epinephrine (1 : 80 000 and 1 : 200 000) in patients with symptomatic irreversible pulpitis. Sixty-two adult volunteers, actively experiencing pain, were randomly allocated into 2 groups and received 1.8 mL of 2% lidocaine with either 1 : 80 000 or 1 : 200 000 epinephrine concentration. Endodontic access preparation was initiated 15 min after the initial IANB. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Secondary outcome measure was the pain experienced during LA solution deposition. Statistical analysis was performed using Mann-Whitney U-test and chi-square test. The anaesthetic success rates of 2% lidocaine solutions containing 1 : 80 000 and 1 : 200 000 epinephrine concentrations were 20% and 28%, respectively. The difference was not statistically significant. There was also no significant difference in the pain experienced during deposition of the solutions. Two percent lidocaine solution used for IANB achieved similar success rates when used with 1 : 80 000 or 1 : 200 000 epinephrine concentration. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

COMPARATIVE EFFECTS OF GLUCAGON, HYDROCORTISONE AND EPINEPHRINE ON THE PROTEIN METABOLISM OF THE FASTING RAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Izzo, J.L.; Glasser, S.R.; Crump, S.L.

An approach toward the elucidation of the mechanism of glucagon in promotirg protein catabolism has been made by comparirg the effects of glucagon and hydrocortisone using female rats fasted five days. The possible relationship of the level of liver glycogen to protein catabolism has also been investigated by comparing the action of glucagon and epinephrine. Both glucagon and hydrocortisonetreated animals lost more weight and excreted more urinary nitrogen, phosphorus, and creatinine than controls. The rate of excretion of glucagon-treated rats declined progressively whereas that of hydrocortisone- treated rats increased progressively throughout the course of the experiment. Although the animals inmore » both groups lost similar amounts of urinary nitrogen the glucagon-treated rats lost less body weight, tissue protein and urinary phosphorus, Furthermore, hydrocortisone caused an elevation in the level of blood alpha -amino nitrogen whereas glucagon caused blood alpha -amino nitrogen to be depressed. These results suggest that glucagon and hydrocortisone cause protein catabolism by different mechanisms. It is proposed that glucagon acts directly on the liver to facilitate the catabolism of amino acids in contrast to the postulated action of hydrocortisone in mobilizing amino acids from extrahepatic tissues. Epinephrine and glucagon depressed liver glycogen but the glycogenolytic effect of epinephrine was of borderline significance, However, epinephrine-treated rats did not differ from controls in respect to any of the above mentioned parameters of protein metabolism. This suggests that the protein catabolic action of glucagon is not directly a consequence of reduced hepatic glycogen. (auth)« less

Epinephrine syringe exchange events in a paediatric cardiovascular ICU: analysing the storm.

PubMed

Achuff, Barbara-Jo; Achuff, Jameson C; Park, Hwan H; Moffett, Brady; Acosta, Sebastian; Rusin, Craig G; Checchia, Paul A

2018-03-01

Introduction Haemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control). Materials and methods Beat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children's Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data. In all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data. This novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.

Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis.

PubMed

Facciorusso, Antonio; Di Maso, Marianna; Antonino, Matteo; Del Prete, Valentina; Panella, Carmine; Barone, Michele; Muscatiello, Nicola

2015-08-01

EMR is the standard of care for the resection of large polyps. To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare. After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection. Endoscopic suite at the University of Foggia between 2005 and 2014. Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching. Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients. Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB). The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P=.7). Polidocanol was more effective in preventing both immediate and delayed PPB (P<.001 and P=.003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P=.49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P=.24 and .6, respectively). Absence of randomization. The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Intravenous lipid emulsion alters the hemodynamic response to epinephrine in a rat model.

PubMed

Carreiro, Stephanie; Blum, Jared; Jay, Gregory; Hack, Jason B

2013-09-01

Intravenous lipid emulsion (ILE) is an adjunctive antidote used in selected critically ill poisoned patients. These patients may also require administration of advanced cardiac life support (ACLS) drugs. Limited data is available to describe interactions of ILE with standard ACLS drugs, specifically epinephrine. Twenty rats with intra-arterial and intravenous access were sedated with isoflurane and split into ILE or normal saline (NS) pretreatment groups. All received epinephrine 15 μm/kg intravenously (IV). Continuous mean arterial pressure (MAP) and heart rate (HR) were monitored until both indices returned to baseline. Standardized t tests were used to compare peak MAP, time to peak MAP, maximum change in HR, time to maximum change in HR, and time to return to baseline MAP/HR. There was a significant difference (p = 0.023) in time to peak MAP in the ILE group (54 s, 95 % CI 44-64) versus the NS group (40 s, 95 % CI 32-48) and a significant difference (p = 0.004) in time to return to baseline MAP in ILE group (171 s, 95 % CI 148-194) versus NS group (130 s, 95 % CI 113-147). There were no significant differences in the peak change in MAP, peak change in HR, time to minimum HR, or time to return to baseline HR between groups. ILE-pretreated rats had a significant difference in MAP response to epinephrine; ILE delayed the peak effect and prolonged the duration of effect of epinephrine on MAP, but did not alter the peak increase in MAP or the HR response.

Role of basal stress hormones and amygdala dimensions in stress coping strategies of male rhesus monkeys in response to a hazard-reward conflict.

PubMed

Tekieh, Elaheh; Riahi, Esmail; Kazemi, Masoomeh; Sahraei, Hedayat; Tavakoli, Hassan; Aliyary, Hamed; Hajinasrollah, Mostafa; Salehi, Maryam; Meftahi, Gholamhossein; Saberi, Mehdi

2017-08-01

In the present study the effect of stress on monkeys that had learned to retrieve food from a five-chamber receptacle, as well as the relationship between their behavior and the serum cortisol and epinephrine levels and relative size of the amygdala was evaluated. Six male rhesus monkeys were individually given access to the food reward orderly. They could easily retrieve the rewards from all chambers except for the chamber 4, which a brief, mild electric shock (3 V) was delivered to them upon touching the chamber's interior. The coping behaviors were video-recorded and analyzed offline. Baseline serum cortisol and epinephrine levels were measured before the experiments using monkey enzyme-linked immunosorbent assay kit. One week after the behavioral experiment, the monkeys' brains were scanned using magnetic resonance imaging under general anesthesia. The cross-sectional area of the left amygdala in sagittal plane relative to the area of the whole brain in the same slice was evaluated by the planimetric method using ImageJ software. Exposure to the distressing condition caused different behavioral responses. Monkeys with higher baseline levels of serum cortisol and epinephrine and larger amygdala behaved more violently in the face of stress, indicating adopting emotion-focused stress-coping strategies. Conversely, those with low plasma epinephrine, moderate cortisol, and smaller amygdala showed perseverative behavior, indicating a problem-focused coping style. In dealing with the same stress, different responses might be observed from nonhuman primates according to their cortisol and epinephrine levels as well as their amygdala dimensions.

Management and educational status of adult anaphylaxis patients at emergency department.

PubMed

Kim, Mi-Yeong; Park, Chan Sun; Jeong, Jae-Won

2017-12-28

We evaluated the management and educational status of adult anaphylaxis patients at emergency departments (EDs). Anaphylaxis patients who visited ED from 2011 to 2013 were enrolled from three hospitals. We analyzed clinical features, prior history of anaphylaxis, management and provided education for etiology and/or prevention. For analyzing associated factors with epinephrine injection, Pearson chi-square test was used by SPSS version 21 (IBM Co.). A total of 194 anaphylaxis patients were enrolled. Ninety-nine patients (51%) visited ED by themselves. Time interval from symptom onset to ED visit was 62 ± 70.5 minutes. Drug (56.2%) was the most frequent cause of anaphylaxis. Forty-seven patients (24.2%) had prior history of anaphylaxis and 33 patients had same suspicious cause with current anaphylaxis. Cutaneous (88.7%) and respiratory (72.7%) symptoms were frequent. Hypotension was presented in 114 patients (58.8%). Mean observation time in ED was 12 ± 25.7 hours and epinephrine was injected in 114 patients (62%). In 68 patients, epinephrine was injected intramuscularly with mean dose of 0.3 ± 0.10 mg. Associated factor with epinephrine injection was hypotension (p = 0.000). Twenty-three patients (13%) were educated about avoidance of suspicious agent. Epinephrine auto-injectors were prescribed only in five patients. Only 34 (19%) and 72 (40%) patients were consulted to allergist at ED and outpatient allergy department respectively. We suggested that management and education of anaphylaxis were not fully carried out in ED. An education and promotion program on anaphylaxis is needed for medical staff.

Pharmacokinetic basis for nonadditivity of intraocular pressure lowering in timolol combinations.

PubMed

Lee, V H; Luo, A M; Li, S Y; Podder, S K; Chang, J S; Ohdo, S; Grass, G M

1991-10-01

The authors determined whether the ocular absorption of topically applied timolol in the pigmented rabbit was affected significantly by coadministration with either pilocarpine or epinephrine in the same drop to explain the nonadditivity in intraocular pressure lowering (IOP) seen clinically. They instilled 25 microliters of 0.65% timolol maleate solution (equivalent to 0.5% timolol), both in the presence and absence of 2.6% pilocarpine nitrate or 1% epinephrine bitartrate, into pigmented rabbit eyes. The time course of timolol concentration in the conjunctiva, anterior sclera, corneal epithelium, corneal stroma, aqueous humor, iris-ciliary body, and lens was monitored for 360 min by using reversed-phase high-performance liquid chromatography. The area under the timolol concentration-time curve in all but one of the anterior segment tissues was reduced by 20-50% (mean, 40%) when timolol was coadministered with pilocarpine and by 20-70% (mean, 42%) when timolol was coadministered with epinephrine. Such an effect was not a result of alterations in corneal permeability or aqueous humor turnover rate, nor was it related to the extent of systemic absorption caused by pilocarpine and epinephrine. Rather, the reduction in ocular timolol absorption may have been caused by the accelerated washout of timolol by tears stimulated by the coadministered drugs and, to a lesser extent, by the loss of timolol through binding to the increased amount of tear proteins induced by the coadministered drugs. Thus, the nonadditivity in IOP lowering from timolol-pilocarpine and timolol-epinephrine combinations is probably caused by changes in precorneal timolol clearance.

Tourniquet application and epinephrine injection to penile skin: is it safe?

PubMed

Cakmak, M; Caglayan, F; Kisa, U; Bozdogan, O; Saray, A; Caglayan, O

2002-09-01

Although a tourniquet is frequently used in penile surgery there is still no consensus on safe application time. The aim of the present study is to investigate the effect of malondialdehyde (MDA) levels and histological changes in skin flaps after penile tourniquet application and epinephrine injection. A total of 36 male white New Zealand rabbits were randomly divided into six groups each containing six animals. A Mathieu-like flap was raised in all of the groups and a tourniquet was applied and the penis was subjected to ischemia for 10, 20 and 40 min in groups 1, 2 and 3, respectively. The flaps were then allowed to reperfuse for 5 min. Biopsies for MDA measurement were harvested in these groups. Subcutaneous 1/200,000 epinephrine was injected into penile skin in group 4 and 5 rabbits and biopsies for MDA measurement were harvested 10 and 40 min after injection. The control group was anesthetized without tourniquet usage or epinephrine injection. Specimens taken from the harvested flaps of all groups were submitted for histological evaluation. The mean MDA levels in all experimental groups were higher than in the control group and the difference was statistically significant. Edema, congestion and extravasation were observed in groups 1, 2 and 3. Minimal congestion and edema were observed in group 4 and severe edema and extravasation in group 5. Tourniquet usage for a duration of less than 10 min is clearly safer than prolonged usage. Epinephrine injection to penile skin may show a deleterious effect on wound healing.

Anesthetic efficacy of the intraosseous injection of 2% lidocaine (1:100,000 epinephrine) and 3% mepivacaine in mandibular first molars.

PubMed

Replogle, K; Reader, A; Nist, R; Beck, M; Weaver, J; Meyers, W J

1997-01-01

This study compared the anesthetic efficacy of a primary intraosseous injection of 2% lidocaine with 1:100,000 epinephrine and 3% mepivacaine in human mandibular first molars. Injection pain and healing postoperatively were also assessed for the intraosseous injection. With the use of a repeated-measures design, 42 subjects randomly received intraosseous injections of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine or 1.8 ml of 3% mepivacaine in a double-blind manner at two successive appointments. The first molar and adjacent teeth were blindly tested with an electric pulp tester at 2-minute cycles for 60 minutes. Anesthetic success was defined as no subject response to the maximum output of the pulp tester (80 reading) for two consecutive readings. Anesthetic success occurred in 74% of the first molars with 2% lidocaine with 1:100,000 epinephrine and in 45% with 3% mepivacaine. The difference was statistically significant (p < 0.05). Overall, onset was rapid for the intraosseous injections, the duration of pulpal anesthesia steadily declined over the 60 minutes, the majority of the subjects had no pain or mild pain with perforation and solution deposition, and 5% of the subjects had delayed healing at the perforation sites. The results of this study indicate that the primary intraosseous injection of 2% lidocaine with 1:100,000 epinephrine is more successful and results in a longer duration of pulpal anesthesia as compared with 3% mepivacaine in noninflamed mandibular first molars. Most subjects reported no or mild pain during perforation and injection.

Articaine (4%) with epinephrine (1:100,000 or 1:200,000) in intraosseous injections in symptomatic irreversible pulpitis of mandibular molars: anesthetic efficacy and cardiovascular effects.

PubMed

Pereira, Leandro Augusto Pinto; Groppo, Francisco Carlos; Bergamaschi, Cristiane de Cássia; Meechan, John Gerard; Ramacciato, Juliana Cama; Motta, Rogério Heládio Lopes; Ranali, José

2013-08-01

The aim of this study was to compare the cardiovascular effects and the anesthetic efficacy of intraosseous injections of 4% articaine with 1:100,000 epinephrine (EPI100) or 4% articaine with 1:200,000 epinephrine (EPI200). In this prospective, randomized, double-blind study, 0.9 mL EPI100 and EPI200 solutions were administered for endodontic treatment of mandibular molars with symptomatic irreversible pulpitis in 60 patients. The anesthetic success and pain during anesthesia were evaluated by visual analog scale. The cardiovascular parameters evaluated were heart rate, diastolic/systolic blood pressure, pulse oximetry, and electrocardiogram changes. Both solutions provided high anesthetic efficacy (96.8% and 93.1% for EPI100 and EPI200, respectively; P > .05), and the cardiovascular parameters showed minimal incidences of significant differences throughout the clinical procedure. The epinephrine concentration did not affect the efficacy of 4% articaine, and both solutions produced a high success level of pulpal anesthesia. Intraosseous delivery by slow speed of injection did not induce significant clinical changes in cardiovascular parameters. Copyright © 2013 Elsevier Inc. All rights reserved.

Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty.

PubMed

Lombardi, Adolph V; Berend, Keith R; Mallory, Thomas H; Dodds, Kathleen L; Adams, Joanne B

2004-11-01

The purpose of this study was to determine if an intraoperative intraarticular and soft-tissue injection of local anaesthetic, epinephrine, and morphine has a beneficial effect for total knee arthroplasty. A control group of 138 patients (181 knees) received no intraoperative injection. The study group of 171 patients (197 knees) received intraoperative injection of 0.25% bupivacaine with epinephrine and morphine with 2/3 injected into the soft tissues and 1/3 injected into the joint. Patients having bilateral simultaneous procedures received a divided dose. The pain treatment protocol otherwise was identical. Pain, sedation, rescue narcotic usage, narcotic reversal and blood loss were examined. Pain levels during the immediate postoperative period, blood loss, and bleeding indices were reduced with injection. Considerably more control patients required rescue doses of narcotics. Preemptive analgesia with soft tissue and intra-articular injection of long-acting local anesthetic with epinephrine and morphine provides better pain control in the immediate postoperative period, decreases blood loss, and decreases the need for rescue narcotics and reversal agents. This simple, inexpensive method provides an effective adjunct to a multimodal approach in improving the postoperative course of primary total knee arthroplasty.

[Analgesic effect of intra-artcular fentanyl in knee arthroscopy to treat patellofemoral lateral hyperpressure syndrome].

PubMed

Gutiérrez-Mendoza, Israel; Pérez-Correa, José J; Serna-Vela, Francisco; Góngora-Ortega, Javier; Vilchis-Huerta, Ventura; Pérez-Guzmán, Carlos; Hernández-Garduño, Eduardo; Vidal-Rodríguez, Francisco Alberto

2009-01-01

During arthroscopy for the treatment of patellofemoral lateral hyper-pressure syndrome (LHS), intra-articular morphine or its derivatives (fentanyl) may reduce postoperative pain when combined with anesthetics. We therefore decided to determine whether adding fentanyl to epinephrine and bupivacaine produced an increased analgesia. We randomly distributed 40 patients into two groups. The experimental group (n=20) was given 0.5% bupivacaine (2 mg/kg), epinephrine (100 microg) and fentanyl (2.5 microg/kg). The control group (n=20) received 0.5% bupivacaine (2 mg/kg) and epinephrine (100 microg). Patients underwent chondroplasty and retinacular release, and we assessed pain, time of analgesia and postoperative range of motion at postoperative hours 6 and 24. The age and the grade of patellofemoral chondromalacia (PFC) were similar in both groups (p > 0.05). No differences were found in pain and ranges of motion intraoperatively and at postoperative hours 6 and 24 (p > 0.05) between both groups. The postoperative analgesia time was similar (p > 0.05). Adding intra-articular fentanyl to the combination of epinephrine plus bupivacaine did not decrease pain, and did not increase neither the analgesia time nor the range of motion in patients with LHS undergoing knee arthroscopy.

A Prospective, Randomized, Double-Blind Comparison of 2% Mepivacaine With 1 : 20,000 Levonordefrin Versus 2% Lidocaine With 1 : 100,000 Epinephrine for Maxillary Infiltrations

PubMed Central

Lawaty, Ingrid; Drum, Melissa; Reader, Al; Nusstein, John

2010-01-01

The purpose of this prospective, randomized, double-blind crossover study was to compare the anesthetic efficacy of 2% mepivacaine with 1 : 20,000 levonordefrin versus 2% lidocaine with 1 : 100,000 epinephrine in maxillary central incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary central incisor and first molar infiltrations of 1.8 mL of 2% mepivacaine with 1 : 20,000 levonordefrin and 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine at 2 separate appointments spaced at least 1 week apart. The teeth were electric pulp tested in 2-minute cycles for a total of 60 minutes. Anesthetic success (obtaining 2 consecutive 80 readings with the electric pulp tester within 10 minutes) was not significantly different between 2% mepivacaine with 1 : 20,000 levonordefrin and 2% lidocaine with 1 : 100,000 epinephrine for the central incisor and first molar. However, neither anesthetic agent provided an hour of pulpal anesthesia. PMID:21174567

Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.

PubMed

Nusstein, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-07-01

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.

Separation and determination of epinephrine and dopamine in traditional Chinese medicines by micellar electrokinetic capillary chromatography with laser induced fluorescence detection.

PubMed

Dong, Yuming; Chen, Hongli; Chen, Yonglei; Hui, Yang; Chen, Xingguo; Hu, Zhide

2006-08-01

A micellar electrokinetic capillary chromatography method with laser-induced fluorescence detection was developed for the analysis of epinephrine and dopamine after derivatization with 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole. The optimum derivatization conditions were: 30 mM sodium borate (pH adjusted to 8.0 with 1.0 M HCl), reaction time 30 min at 60 degrees C. Baseline separation was achieved within 14 min with a running buffer composed of 10 mM sodium borate + 25 mM sodium dodecyl sulfate (pH adjusted to 9.5 with 0.1 M NaOH) and an applied voltage of 15 kV. Good linearity relationships (correlation coefficients: 0.9991 for epinephrine and 0.9985 for dopamine) between peak areas and concentrations of the analytes were obtained. The detection limits and quantification limits for epinephrine and dopamine were 0.0038 mg/L and 0.013 mg/L, and 0.065 mg/L and 0.020 mg/L, respectively. The method was applied to the analysis of the two compounds in two Chinese medicines with recoveries in the range of 92.6-108.7%.

Plasma glucose and nonesterified fatty acids response to epinephrine challenges in dairy cows during a 670-d lactation.

PubMed

Marett, L C; Auldist, M J; Wales, W J; Macmillan, K L; Dunshea, F R; Leury, B J

2018-04-01

This experiment investigated the metabolic response to a 2-dose epinephrine challenge of dairy cows undergoing an extended lactation. Twelve multiparous Holstein-Friesian cows that calved in late winter in a seasonally calving pasture-based dairying system were managed for a 670-d lactation by delaying rebreeding. In each of four 40-d experimental periods commencing at 73, 217, 422, and 520 (±9.1) d in milk (DIM), cows were offered a diet of perennial ryegrass (73 and 422 DIM) or pasture hay and silage (217 and 520 DIM), supplemented with 1 (CON; n = 6) or 6 kg of grain (GRN; n = 6) as a ration. Daily energy intake was approximately 160 and 215 MJ of metabolizable energy/cow for the CON and GRN treatments, respectively. At all other times, cows were managed as a single herd and grazed pasture supplemented with grain to an estimated daily total intake of 180 MJ of metabolizable energy/cow. Cows were fitted with a jugular catheter during the final week of each experimental period. Two doses of epinephrine (0.1 and 1.6 µg/kg of body weight) were infused via the catheter 2 h apart to each cow at approximately 100, 250, 460, and 560 DIM. Blood plasma concentrations of glucose and nonesterified fatty acids (NEFA) were measured before and after infusions. Cows in the GRN treatment had greater milk yield, milk fat and protein yields, and body weight than cows in the CON treatment. The maximum plasma glucose concentration was observed at 100 DIM for both the low and high doses of epinephrine. Thus, sensitivity and responsiveness to exogenous epinephrine were greater during early lactation, coinciding with increased priority of milk synthesis. Both the sensitivity and responsiveness to epinephrine decreased with decreasing milk yield, as measured by the acute appearance of NEFA in the plasma. Increased plasma glucose and NEFA clearance rates before 300 DIM indicated greater uptake of these substrates by the mammary gland for milk synthesis in early and mid lactation. These results support previous findings that major changes occur in terms of adipose tissue metabolism during extended lactations. Overall, sensitivity to epinephrine was not affected by diet, but responsiveness was greater in cows fed the GRN diet. The endocrine regulation of nutrient partitioning throughout traditional and extended lactations is complex, with many interactions between stage of lactation, diet, and milk yield potential. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

An Intervention to Increase High School Students' Compliance with Carrying Auto-Injectable Epinephrine: A MASNRN Study

ERIC Educational Resources Information Center

Spina, Jennifer L.; McIntyre, C. Lynne; Pulcini, Joyce A.

2012-01-01

Adolescents with life-threatening allergies are at a greater risk for a fatal anaphylactic event since only about half of them carry unexpired epinephrine available for emergency use. The aim of this study was to test the effectiveness of school nurse interventions that consisted of either routine or periodic checks during the school year for the…

Epinephrine-Induced and Antiapoptotic Signaling in Prostate Cancer

DTIC Science & Technology

2009-05-01

Phosphorylation of ectopically expressed HA-BAD mirrors endogenous BAD phosphorylation, thus analysis of HA-BAD allows adequately interpret modifications...subjected to emotional stress (Fig.2 A). However, more extensive analysis of CREB phosphorylation in C42Luc xenografts showed that in some cases...data indicate that assignment of tumor samples for analysis of signaling pathways should be done based on blood epinephrine measurements. Given

Behavioral Response of Dolphins to Signals Simulating Mid-Frequency Sonar

DTIC Science & Technology

2010-09-30

for cortisol and aldosterone and inspected for parallelism to determine whether a prolonged stress response is triggered by the sound exposure event...radioimmunoassay to assess circulating levels of corticosteroid hormones (cortisol and aldosterone ) and catecholamines (epinephrine). Levels will be compared...collected from the bottlenose dolphins. All samples have been processed for cortisol, aldosterone , and epinephrine. Assay kits have been validated for the

Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis.

PubMed

Shadmehr, E; Aminozarbian, M G; Akhavan, A; Mahdavian, P; Davoudi, A

2017-06-01

This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15 μg mL -1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5 μg mL -1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30 min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P < 0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery.

PubMed

da Silva-Junior, Geraldo Prisco; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery.

The Consistency in Macronutrient Oxidation and the Role for Epinephrine in the Response to Fasting and Overfeeding

PubMed Central

Schlögl, Mathias; Piaggi, Paolo; Hohenadel, Maximilian; Graham, Alexis; Bonfiglio, Susan; Krakoff, Jonathan; Thearle, Marie S.

2017-01-01

Context: In humans, dietary vs intraindividual determinants of macronutrient oxidation preference and the role of the sympathetic nervous system (SNS) during short-term overfeeding and fasting are unclear. Objective: To understand the influence on metabolic changes of diet and SNS during 24 hours of overfeeding. Design, Setting, Participants, and Interventions: While residing on a clinical research unit, 64 participants with normal glucose regulation were assessed during energy balance, fasting, and four 24-hour overfeeding diets, given in random order. The overfeeding diets contained 200% of energy requirements and varied macronutrient proportions: (1) standard (50% carbohydrate, 20% protein, and 30% fat); (2) 75% carbohydrate; (3) 60% fat; and (4) 3% protein. Main Outcome Measures: Twenty-four–hour energy expenditure (EE) and macronutrient oxidation rates were measured in an indirect calorimeter during the dietary interventions, with concomitant measurement of urinary catecholamines and free cortisol. Results: EE decreased with fasting (−7.7% ± 4.8%; P < 0.0001) and increased with overfeeding. The smallest increase occurred during consumption of the diet with 3% protein (2.7% ± 4.5%; P = 0.001) and the greatest during the diet with 75% carbohydrate (13.8 ± 5.7%; P < 0.0001). Approximately 60% of macronutrient oxidation was determined by diet and 20% by intrinsic factors (P < 0.0001). Only urinary epinephrine differed between fasting and overfeeding diets (Δ = 2.25 ± 2.9 µg/24h; P < 0.0001). During fasting, higher urinary epinephrine concentrations correlated with smaller reductions in EE (ρ = 0.34; P = 0.01). Conclusions: Independent from dietary macronutrient proportions, there is a strong individual contribution to fuel preference that remains consistent across diets. Higher urinary epinephrine levels may reflect the importance of epinephrine in maintaining EE during fasting. PMID:27820654

Preparation and characterization of reduced graphene oxide supported nickel oxide nanoparticle-based platform for sensor applications

NASA Astrophysics Data System (ADS)

Roychoudhury, Appan; Prateek, Arneish; Basu, Suddhasatwa; Jha, Sandeep Kumar

2018-03-01

A nanostructured composite film comprising reduced graphene oxide (rGO) and nickel oxide (NiO) nanoparticles (NPs) has been prepared and utilized for development of a simple yet efficient sensor for detection of dopamine and epinephrine in a single run. The hybrid material rGO-NiO nanocomposite was synthesized chemically, and the formation of nanocomposite was confirmed via X-ray diffraction (XRD), transmission electron microscopy (TEM), Raman, UV-Vis, and Fourier transform infrared (FTIR) spectroscopic techniques. The incorporation of NiO NPs on rGO support was found to provide improved sensing characteristics at electrode interface due to enhanced electron mobility on rGO sheet and high catalytic activity of NiO NPs. Subsequently, the synthesized rGO-NiO nanocomposite was deposited onto indium tin oxide (ITO)-coated glass substrate by simple drop-casting method, and the electrode was characterized through atomic force microscopy (AFM) and scanning electron microscopic (SEM) studies. After optimization of experimental conditions electrochemically for its high sensitivity, the fabricated rGO-NiO/ITO electrode was used for simultaneous detection of dopamine and epinephrine by square wave voltammetry (SWV) method. The results showed high sensitivity of 0.545 and 0.638 μA/μM for dopamine and epinephrine respectively in a broad linear range of 0.5-50 μM. Moreover, remarkable detection limits of 0.495 and 0.423 μM were found for dopamine and epinephrine, and the developed sensor exhibited a wide separation of 380 mV between the respective detection peaks of dopamine and epinephrine. Beside this, the proposed sensor was successfully applied in presence of high concentration of interfering agents, ascorbic acid and uric acid, and validated with real serum samples.

Simultaneous determination of epinephrine and dopamine by electrochemical reduction on the hybrid material SiO₂/graphene oxide decorated with Ag nanoparticles.

PubMed

Cincotto, Fernando H; Canevari, Thiago C; Campos, Anderson M; Landers, Richard; Machado, Sérgio A S

2014-09-21

This paper describes the synthesis, characterization and applications of a new hybrid material composed of mesoporous silica (SiO2) modified with graphene oxide (GO), SiO2/GO, obtained by the sol-gel process using HF as the catalyst. The hybrid material, SiO2/GO, was decorated with silver nanoparticles (AgNPs) with a size of less than 20 nanometres, prepared directly on the surface of the material using N,N-dimethylformamide (DMF) as the reducing agent. The resulting material was designated as AgNP/SiO2/GO. The Ag/SiO2/GO material was characterized by X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), energy-dispersive X-ray (EDX) and high-resolution transmission electron microscopy (HR-TEM). A glassy carbon electrode modified with AgNP/SiO2/GO was used in the development of a sensitive electrochemical sensor for the simultaneous determination of epinephrine and dopamine employing electrocatalytic reduction using squarewave voltammetry. Well-defined and separate reduction peaks were observed in PBS buffer at pH 7. No significant interference was seen for primarily biological interferents such as uric acid and ascorbic acid in the detection of dopamine and epinephrine. Our study demonstrated that the resultant AgNP/SiO2/GO-modified electrode is highly sensitive for the simultaneous determination of dopamine and epinephrine, with the limits of detection being 0.26 and 0.27 μmol L(-1), respectively. The AgNP/SiO2/GO-modified electrode is highly selective and can be used to detect dopamine and epinephrine in a human urine sample.

Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding.

PubMed

Hyldebrandt, Janus Adler; Sivén, Eleonora; Agger, Peter; Frederiksen, Christian Alcaraz; Heiberg, Johan; Wemmelund, Kristian Borup; Ravn, Hanne Berg

2015-07-01

Right ventricular (RV) failure due to chronic pressure overload is a main determinant of outcome in congenital heart disease. Medical management is challenging because not only contractility but also the interventricular relationship is important for increasing cardiac output. This study evaluated the effect of milrinone alone and in combination with epinephrine or dopamine on hemodynamics, ventricular performance, and the interventricular relationship. RV failure was induced in 21 Danish landrace pigs by pulmonary artery banding. After 10 wk, animals were reexamined using biventricular pressure-volume conductance catheters. The maximum pressure in the RV increased by 113% (P < 0.0001) and end-diastolic volume by 43% (P < 0.002), while left ventricular (LV) pressure simultaneously decreased (P = 0.006). Concomitantly, mean arterial pressure (MAP; -16%, P = 0.01), cardiac index (CI; -23%, P < 0.0001), and mixed venous oxygen saturation (SvO2 ; -40%, P < 0.0001) decreased. Milrinone increased CI (11%, P = 0.008) and heart rate (HR; 21%, P < 0.0001). Stroke volume index (SVI) decreased (7%, P = 0.03), although RV contractility was improved. The addition of either epinephrine or dopamine further increased CI and HR in a dose-dependent manner but without any significant differences between the two interventions. A more pronounced increase in biventricular contractility was observed in the dopamine-treated animals. LV volume was reduced in both the dopamine and epinephrine groups with increasing doses In the failing pressure overloaded RV, milrinone improved CI and increased contractility. Albeit additional dose-dependent effects of both epinephrine and dopamine on CI and contractility, neither of the interventions improved SVI due to reduced filling of the LV. Copyright © 2015 the American Physiological Society.

Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in right heart failure after pulmonary regurgitation.

PubMed

Hyldebrandt, Janus Adler; Agger, Peter; Sivén, Eleonora; Wemmelund, Kristian Borup; Heiberg, Johan; Frederiksen, Christian Alcaraz; Ravn, Hanne Berg

2015-09-01

Right ventricular failure (RVF) secondary to pulmonary regurgitation (PR) impairs right ventricular (RV) function and interrupts the interventricular relationship. There are few recommendations for the medical management of severe RVF after prolonged PR. PR was induced in 16 Danish landrace pigs by plication of the pulmonary valve leaflets. Twenty-three pigs served as controls. At reexamination the effect of milrinone, epinephrine, and dopamine was evaluated using biventricular conductance and pulmonary catheters. Seventy-nine days after PR was induced, RV end-diastolic volume index (EDVI) had increased by 33% (P = 0.006) and there was a severe decrease in the load-independent measurement of contractility (PRSW) (-58%; P = 0.003). Lower cardiac index (CI) (-28%; P < 0.0001), mean arterial pressure (-15%; P = 0.01) and mixed venous oxygen saturation (SvO2) (36%; P < 0.0001) were observed compared with the control group. The interventricular septum deviated toward the left ventricle (LV). Milrinone improved RV-PRSW and CI and maintained systemic pressure while reducing central venous pressure (CVP). Epinephrine and dopamine further improved biventricular PRSW and CI equally in a dose-dependent manner. Systemic and pulmonary pressures were higher in the dopamine-treated animals compared with epinephrine-treated animals. None of the treatments improved stroke volume index (SVI) despite increases in contractility. Strong correlation was detected between SVI and LV-EDVI, but not SVI and biventricular contractility. In RVF due to PR, milrinone significantly improved CI, SvO2, and CVP and increased contractility in the RV. Epinephrine and dopamine had equal inotropic effect, but a greater vasopressor effect was observed for dopamine. SV was unchanged due to inability of both treatments to increase LV-EDVI. Copyright © 2015 the American Physiological Society.

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery

PubMed Central

da Silva-Junior, Geraldo Prisco; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

2017-01-01

In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery. PMID:28604089

The effect of local anesthetics administered via pain pump on chondrocyte viability.

PubMed

Dragoo, Jason L; Korotkova, Tatiana; Kanwar, Raj; Wood, Billy

2008-08-01

Chondrolysis initiated by postoperative, intra-articular pain pumps has recently been described by multiple institutions. To evaluate the in vitro chondrotoxicity of anesthetic formulations commonly used in pain pumps. Controlled laboratory study. Freshly isolated human articular chondrocytes were cultured for 24-, 48-, and 72-hour trials in a custom bioreactor that mimics the metabolism of synovial fluid. Chondrocytes were perfused in Dulbecco's Modified Eagle's Medium 10% fetal bovine serum and one of the following medications: 1% lidocaine, 1% lidocaine with epinephrine, 0.25% bupivacaine, 0.25% bupivacaine with epinephrine, 0.5% bupivacaine, or 0.5% bupivacaine with epinephrine. Static and perfusion cultures with growth media were used as controls. All experiments were run in duplicate. Live/dead staining was performed, and the ratio of dead:live cells was assessed by fluorescent microscopy and histomorphometry. Significantly more chondrocyte necrosis was found in all cultures with medications containing epinephrine (P < .05) at all time points. Similar necrosis rates were exhibited in 0.25% and 0.5% bupivacaine compared with controls at 24 and 48 hours. However, 0.5% bupivacaine produced significantly more cell death at 72 hours. Similar necrosis rates were exhibited with 1% lidocaine compared to controls at 24 hours. In this in vitro model, 0.25% and 0.5% bupivacaine caused minimal chondrocyte necrosis when used in pain pumps for a maximum of 48 hours. All anesthetics containing epinephrine (pH

Posttranscriptional regulation of adrenal TH gene expression contributes to the maladaptive responses triggered by insulin-induced recurrent hypoglycemia.

PubMed

Kudrick, Necla; Chan, Owen; La Gamma, Edmund F; Kim, Juhye Lena; Tank, Arnold William; Sterling, Carol; Nankova, Bistra B

2015-02-01

Acute metabolic stress such as insulin-induced hypoglycemia triggers a counterregulatory response during which the release of catecholamines (epinephrine), the activation of tyrosine hydroxylase (TH) enzyme and subsequent compensatory catecholamine biosynthesis occur in the adrenal medulla. However, recurrent exposure to hypoglycemia (RH), a consequence of tight glycemic control in individuals with type 1 and type 2 diabetes compromises this physiological response. The molecular mechanisms underlying the maladaptive response to repeated glucose deprivation are incompletely understood. We hypothesize that impaired epinephrine release following RH reflects altered regulation of adrenal catecholamine biosynthesis. To test this hypothesis, we compared the effect of single daily (RH) and twice-daily episodes of insulin-induced hypoglycemia (2RH) on adrenal epinephrine release and production in normal rats. Control animals received saline injections under similar conditions (RS and 2RS, respectively). Following 3 days of treatment, we assessed the counterregulatory hormonal responses during a hypoglycemic clamp. Changes in adrenal TH gene expression were also analyzed. The counterregulatory responses, relative TH transcription and TH mRNA levels and Ser40-TH phosphorylation (marker for enzyme activation) were induced to a similar extent in RS, 2RS, and RH groups. In contrast, epinephrine and glucagon responses were attenuated in the 2RH group and this was associated with a limited elevation of adrenal TH mRNA, rapid inactivation of TH enzyme and no significant changes in TH protein. Our results suggest that novel posttranscriptional mechanisms controlling TH mRNA and activated TH enzyme turnover contribute to the impaired epinephrine responses and may provide new therapeutic targets to prevent HAAF. © 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Anaphylaxis: a payor's perspective on epinephrine autoinjectors.

PubMed

Dunn, Jeffrey D; Sclar, David A

2014-01-01

The scope of expenditures due to anaphylaxis likely is underestimated by health care payors because anaphylaxis is underdiagnosed and, when reported, most costs of anaphylaxis borne by payors relate to direct medical expenses. Direct costs of anaphylaxis have been estimated at $1.2 billion per year, with direct expenditures of $294 million for epinephrine, and indirect costs of $609 million. More accurate diagnostic coding will allow payors to improve their understanding of the full impact of anaphylaxis on health care plans, employers, patients, and their families. Similarly, more accurate diagnosis and treatment of anaphylaxis should have a direct effect on overall cost savings achieved in this disease state. This includes savings in both direct costs, such as emergency department visits, and indirect costs, such as lost productivity of patients and caregivers. Educating medical personnel on treatment guidelines regarding the specific use of appropriate epinephrine autoinjectors will contribute to cost savings. Even though the cost of autoinjectors has been increasing, evidence indicates that the cost of improper response to, and treatment of, anaphylaxis outweighs that increase. At this time, there are several branded epinephrine autoinjectors and one generic equivalent for one of these branded products available on the US market; the branded autoinjectors are not considered equivalents for substitution. Barriers to coverage and access, such as managed care organization tier classification, medication copay, and socioeconomic status of specific patients, need to be examined more closely and addressed. Education in the proper use of epinephrine autoinjectors, including regular checking of medication expiration dates, is critical for proper management of anaphylaxis and minimizing the costs of anaphylactic events. Managed care organizations can play a role in educational initiatives. Copyright © 2014 Elsevier Inc. All rights reserved.

Reactions to prick and intradermal skin tests.

PubMed

Bagg, Andrew; Chacko, Thomas; Lockey, Richard

2009-05-01

Allergy skin testing is a common procedure for the diagnosis of atopic diseases with a small risk of systemic reactions. To determine the 12-month incidence of systemic reactions (SRs) to skin prick testing (SPT) and intradermal skin testing (ST) and the symptoms and response to immediate treatment with epinephrine intramuscularly. A prospective study was conducted to evaluate SRs from ST in 1,456 patients. A standard form was used to record symptoms, signs, and treatment. The SRs are defined as any sign or symptom other than a local reaction thought to be secondary to ST. No vasovagal reactions were included. Nurses, as instructed by attending physicians, administered epinephrine (0.2 mL of a 1:1,000 dilution) intramuscularly in the deltoid as soon as any remote signs or symptoms occurred. Fifty-two patients (3.6%) had SRs (6 SPT and 46 intradermal): 43 (83%) were female, and 17 (33%) had asthma. Systemic symptoms included (SPT/intradermal) pruritic eyes, nose, or pharynx (0%/46%); worsening cough (50%/26%); sensation of difficulty swallowing (0%/20%); worsening nasal congestion (17%/15%); rhinorrhea (17%/13%); chest tightness or shortness of breath (33%/11%); generalized pruritus (17%/11%); sneezing (33%/9%); wheeze (0%/4%); and urticaria (17%/2%). No severe asthma, shock, hypotension, unconsciousness, or biphasic reactions occurred. All 52 patients received epinephrine intramuscularly, 48 (92%) oral prednisone, 9 (17%) oral prednisone to take 6 to 8 hours after a reaction, 50 (96%) oral antihistamine, and 6 (12%) nebulized beta-agonist. Of patients who underwent ST, SRs occurred in 3.6% (0.4% for SPT and 3.2% for intradermal ST), all of whom readily responded to epinephrine intramuscularly in the deltoid. This immediate administration of epinephrine seems to prevent more serious and biphasic reactions.

Sympathetic activity in patients with panic disorder at rest, under laboratory mental stress, and during panic attacks.

PubMed

Wilkinson, D J; Thompson, J M; Lambert, G W; Jennings, G L; Schwarz, R G; Jefferys, D; Turner, A G; Esler, M D

1998-06-01

The sympathetic nervous system has long been believed to be involved in the pathogenesis of panic disorder, but studies to date, most using peripheral venous catecholamine measurements, have yielded conflicting and equivocal results. We tested sympathetic nervous function in patients with panic disorder by using more sensitive methods. Sympathetic nervous and adrenal medullary function was measured by using direct nerve recording (clinical microneurography) and whole-body and cardiac catecholamine kinetics in 13 patients with panic disorder as defined by the DSM-IV, and 14 healthy control subjects. Measurements were made at rest, during laboratory stress (forced mental arithmetic), and, for 4 patients, during panic attacks occurring spontaneously in the laboratory setting. Muscle sympathetic activity, arterial plasma concentration of norepinephrine, and the total and cardiac norepinephrine spillover rates to plasma were similar in patients and control subjects at rest, as was whole-body epinephrine secretion. Epinephrine spillover from the heart was elevated in patients with panic disorder (P=.01). Responses to laboratory mental stress were almost identical in patient and control groups. During panic attacks, there were marked increases in epinephrine secretion and large increases in the sympathetic activity in muscle in 2 patients but smaller changes in the total norepinephrine spillover to plasma. Whole-body and regional sympathetic nervous activity are not elevated at rest in patients with panic disorder. Epinephrine is released from the heart at rest in patients with panic disorder, possibly due to loading of cardiac neuronal stores by uptake from plasma during surges of epinephrine secretion in panic attacks. Contrary to popular belief, the sympathetic nervous system is not globally activated during panic attacks.

Posttranscriptional regulation of adrenal TH gene expression contributes to the maladaptive responses triggered by insulin-induced recurrent hypoglycemia

PubMed Central

Kudrick, Necla; Chan, Owen; La Gamma, Edmund F; Kim, Juhye Lena; Tank, Arnold William; Sterling, Carol; Nankova, Bistra B

2015-01-01

Acute metabolic stress such as insulin-induced hypoglycemia triggers a counterregulatory response during which the release of catecholamines (epinephrine), the activation of tyrosine hydroxylase (TH) enzyme and subsequent compensatory catecholamine biosynthesis occur in the adrenal medulla. However, recurrent exposure to hypoglycemia (RH), a consequence of tight glycemic control in individuals with type 1 and type 2 diabetes compromises this physiological response. The molecular mechanisms underlying the maladaptive response to repeated glucose deprivation are incompletely understood. We hypothesize that impaired epinephrine release following RH reflects altered regulation of adrenal catecholamine biosynthesis. To test this hypothesis, we compared the effect of single daily (RH) and twice-daily episodes of insulin-induced hypoglycemia (2RH) on adrenal epinephrine release and production in normal rats. Control animals received saline injections under similar conditions (RS and 2RS, respectively). Following 3 days of treatment, we assessed the counterregulatory hormonal responses during a hypoglycemic clamp. Changes in adrenal TH gene expression were also analyzed. The counterregulatory responses, relative TH transcription and TH mRNA levels and Ser40-TH phosphorylation (marker for enzyme activation) were induced to a similar extent in RS, 2RS, and RH groups. In contrast, epinephrine and glucagon responses were attenuated in the 2RH group and this was associated with a limited elevation of adrenal TH mRNA, rapid inactivation of TH enzyme and no significant changes in TH protein. Our results suggest that novel posttranscriptional mechanisms controlling TH mRNA and activated TH enzyme turnover contribute to the impaired epinephrine responses and may provide new therapeutic targets to prevent HAAF. PMID:25713330

Comparative Resuscitation Measures for Drug Toxicities Utilizing Lipid Emulsions

DTIC Science & Technology

2015-01-13

experimental, mixed research design Methods: For each drug studied, seven swine were assigned to eight ACLS or BLS protocol resuscitation groups ...studied drug overdose. For example, with bupivacaine, seventy- one percent of the epinephrine/lipid group survived compared to 19% of all the groups ...surviving. The Epinephrine only group yielded three survivors and the Lipid emulsion only group yielded one survivor. No swine in the CPR only or

Study of the anesthetic efficacy of inferior alveolar nerve block using articaine in irreversible pulpitis.

PubMed

Ahmad, Zeeshan H; Ravikumar, H; Karale, Rupali; Preethanath, R S; Sukumaran, Anil

2014-01-01

The purpose of this study was to determine the anesthetic efficacy of inferior alveolar nerve block (IANB) using 4% articaine and 2% lidocaine supplemented with buccal infiltration. Forty five patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth were included in the study. The first group of 15 patients received 2% lidocaine with 1:200000 epinephrine, the second group 2% lidocaine with 1: 80,000 epinephrine and the third group of 15 subjects received 4% articaine with 1:100000 epinephrine. During the access cavity preparation those patients who complained of pain received an additional buccal infiltration. The percentage of subjects who got profound anesthesia and failure to achieve anesthesia were calculated and tabulated using a visual analog scale. The results revealed that 87% of subjects who received 4% Articaine with 1:100,000 epinephrine got satisfactory anesthesia with inferior alveolar nerve block alone. Only 2 (13%) subjects received an additional buccal infiltration and none of the patients failed to obtain complete anesthesia with articaine. In comparison only 40% of subjects got complete anesthesia with 2% lidocaine with 1:200000 and 60% with 2% lidocaine with 1:80,000. It can be concluded that 4% articaine can be used effectively for obtaining profound anesthesia for endodontic procedures in patients with irreversible pulpitis.

Decreased catecholamine secretion from the adrenal medullae of chronically diabetic BB-Wistar rats

NASA Technical Reports Server (NTRS)

Wilke, R. A.; Riley, D. A.; Lelkes, P. I.; Hillard, C. J.

1993-01-01

Many humans with IDDM eventually lose the capacity to secrete epinephrine from their adrenal medullae. The mechanism for this pathological change is unknown. We hypothesized that this abnormality is attributable to neuropathic changes in the greater splanchnic nerves or in the chromaffin cells that they innervate. To study this hypothesis, we isolated rat adrenal glands, perfused them ex vivo, and measured the epinephrine content of the perfusate under various conditions of stimulation. We used transmural electrical stimulation (20-80 V, at 10 Hz) to induce epinephrine secretion indirectly by selectively activating residual splanchnic nerve terminals within the isolated glands. Under these conditions, epinephrine secretion was severely attenuated in glands from female BB-Wistar rats with diabetes of 4 mo duration compared with their age-matched, nondiabetic controls. These perfused diabetic adrenal medullae also demonstrated decreased catecholamine release in response to direct chromaffin cell depolarization with 20 mM K+, evidence that a functional alteration exists within the chromaffin cells themselves. Nonetheless, total catecholamine content of adrenal medullae from these diabetic rats was not significantly different from controls, indicating that the secretory defect was not simply attributable to a difference in the amount of catecholamines stored and available for release. Herein, we also provide histological evidence of degenerative changes within the cholinergic nerve terminals that innervate these glands.

Epinephrine-induced pulmonary edema during hip arthroscopy: a report of two cases and a review of the literature.

PubMed

Belkin, Nicole S; Degen, Ryan M; Liguori, Gregory A; Kelly, Bryan T

2017-09-01

Hip arthroscopy utilization has significantly increased in recent years. While it is a relatively safe procedure, it is not without risk. Life-threatening complications, albeit rare, can potentially occur and must be appropriately recognized and treated. We describe 2 cases in which patients' undergoing hip arthroscopy developed pulmonary edema and their respective courses of treatment. Both patients were being treated for symptomatic femoroacetabular impingement (FAI), with labral tears, requiring operative management after a failed trial of conservative management. The complication occurred during a primary hip arthroscopy procedure and a retrospective review of their clinical records and intra-operative notes was performed. Hip arthroscopy was performed under spinal anesthetic in the supine position in both patients. In both procedures, patients developed severe hypertension and tachycardia, with subsequent oxygen desaturations with noted pulmonary edema. The postulated etiology was systemic effects from intra-articular epinephrine, causing acute pulmonary edema with corresponding cardiovascular changes. With supportive ventilation, selective alpha-adrenergic blocker and furosemide administration, and cessation of epinephrine exposure, vital signs normalized and both patients experienced symptom resolution. During arthroscopy, if acute hypertension, tachycardia and hypoxia develop, epinephrine-induced pulmonary edema should be considered as a cause by the treating orthopedic surgeon and anesthesiologist in order to initiate an appropriate treatment plan.

The effect of sampling methods on the apparent constituents of ink from the squid Sepioteuthis australis.

PubMed

Madaras, F; Gerber, J P; Peddie, F; Kokkinn, M J

2010-11-01

Results of experiments conducted on ink recovered from the squid Sepioteuthis australis indicate that there is no epinephrine or protein naturally present in the ink as it would be ejected in vivo. Protein content was effectively zero when ink was syringed from the duct end of the ink sac of freshly killed animals. By contrast, there were proteins in samples collected from dead specimens where ink was collected by a stripping method. From these samples, a single large molecular weight protein was identified as having tyrosinase activity. Digestion of syringed ink did not yield signs of melanin-bound proteins. Analysis of supernatants after centrifugation of squid ink consistently revealed the presence of DOPA, dopamine, and taurine, whereas epinephrine and nor-epinephrine were recorded from what was believed to be contaminated ink. Histological investigations of the ink sac revealed a compartmentalised glandular structure distal to the duct end. Closer observation of the glandular tissue showed that compartments increased in size as they matured and moved further into the lumen. It was concluded that the presence of epinephrine and tyrosinase (or a related protein) in the ink of S. australis could be attributed to rupturing of basal glandular compartments or contamination from other sources during the extraction process.

[Update on anaphylactic shock treatment recommendations: what's new in the use of epinephrine?].

PubMed

Bózzola, César Martín; Saranz, Ricardo J; Lozano, Alejandro; Cáceres, María Elena; Sarraquigne, Paula; Mariño, Andrea Irene; Boudet, Raúl Vicente; Bandín, Gloria; Skrie, Víctor

2015-01-01

In 1998, the Sociedad Argentina de Pediatría issued the recommendation of the treatment of anaphylactic shock. While this recommendation suggested the use of subcutaneous epinephrine, currently the intramuscular via is considered the most appropriate one. Pharmacological aspects determine this preference. For outpatient treatment, the correct use of autoinjectors can control anaphylaxis quickly and effectively. The use of other medications in the proposed 1998 recommendation remains unchanged.

Impact of food allergies on school nursing practice.

PubMed

Weiss, Christopher; Muñoz-Furlong, Anne; Furlong, Terence J; Arbit, Julie

2004-10-01

Food allergies affect 11 million Americans, including 6-8% of children. The rate of peanut allergies in children doubled from 1997 to 2002. There is no cure; therefore, strict avoidance of the allergen is the only way to avoid a reaction. Fatalities are associated with delays in or lack of epinephrine administration. Severe reactions, called anaphylaxis, have occurred in schools. In a nationwide telephone survey of 400 elementary school nurses, 44% reported an increase in children with food allergies in their schools over the last 5 years; more than one third had 10 or more students with food allergies; 78% did staff training as a preventive strategy, with 74% developing their own training guidelines; and 90% stated students' epinephrine was stored in the nurse's office. Standardized training in food allergies as well as timely access to epinephrine is needed to respond appropriately to an anaphylactic reaction in the school setting.

Anaphylaxis: lack of hospital doctors' knowledge of adrenaline (epinephrine) administration in adults could endanger patients' safety.

PubMed

Droste, J; Narayan, N

2012-06-01

Adrenaline (epinephrine) is the first line drug to be given in anaphylaxis and can save patients' lives. Conversely, incorrect administration of adrenaline in anaphylaxis has caused patients serious harm, including death. We compared the survey results of doctors' knowledge of adrenaline administration in adults of two District General Hospitals Trusts in England and found, that from 284 Hospital Doctors, 14.4% (n = 41) would administer adrenaline as recommended by published anaphylaxis guidelines. This survey comparison shows that a significant number of hospital doctors, regardless of seniority and specialty, have an educational deficit regarding correct administration of adrenaline (epinephrine) administration in adults with anaphylaxis. Multilevel strategies to educate doctors and prevent patient harm are needed. We propose a mnemonic for remembering the recommended treatment for anaphylaxis in the adult: "A Thigh 500" forAdrenaline into the antero-lateral thigh, 500 micrograms.

Piezoelectric detection of ion pairs between sulphonate and catecholamines for flow injection analysis of pharmaceutical preparations.

PubMed

Mo, Z; Long, X; Zhang, M

1999-03-01

Fundamentals of ion-pair flow injection with piezoelectric detection were investigated experimentally and theoretically for the adsorption of dodecyl phenylsulfonate and interfacial ion-pair formation with epinephrine and l-dopa on silver electrode of quartz crystal microbalance. The influences of sulfonate concentration and operating parameters on the frequency response were demonstrated and provided the possibility for the discriminating determination of mixtures. The selected system of ion-pair flow injection with piezoelectric detection was applied to the determination of epinephrine and l-dopa. Calibration curves were linear in ranges 4.00-850 and 3.50-730 mug ml(-1), with detection limits of 1.22 and 1.05 mug ml(-1) and sampling frequencies of 120 samples h(-1), for epinephrine and l-dopa, respectively. The method has been satisfactorily applied to the determination of catecholamines in pharmaceutical preparations.

Stress Hormones Epinephrine and Corticosterone Selectively Modulate Herpes Simplex Virus 1 (HSV-1) and HSV-2 Productive Infections in Adult Sympathetic, but Not Sensory, Neurons

PubMed Central

Ives, Angela M.

2017-01-01

ABSTRACT Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) infect and establish latency in peripheral neurons, from which they can reactivate to cause recurrent disease throughout the life of the host. Stress is associated with the exacerbation of clinical symptoms and the induction of recurrences in humans and animal models. The viruses preferentially replicate and establish latency in different subtypes of sensory neurons, as well as in neurons of the autonomic nervous system that are highly responsive to stress hormones. To determine if stress-related hormones modulate productive HSV-1 and HSV-2 infections within sensory and autonomic neurons, we analyzed viral DNA and the production of viral progeny after treatment of primary adult murine neuronal cultures with the stress hormones epinephrine and corticosterone. Both sensory trigeminal ganglion (TG) and sympathetic superior cervical ganglion (SCG) neurons expressed adrenergic receptors (activated by epinephrine) and the glucocorticoid receptor (activated by corticosterone). Productive HSV infection colocalized with these receptors in SCG but not in TG neurons. In productively infected neuronal cultures, epinephrine treatment significantly increased the levels of HSV-1 DNA replication and production of viral progeny in SCG neurons, but no significant differences were found in TG neurons. In contrast, corticosterone significantly decreased the levels of HSV-2 DNA replication and production of viral progeny in SCG neurons but not in TG neurons. Thus, the stress-related hormones epinephrine and corticosterone selectively modulate acute HSV-1 and HSV-2 infections in autonomic, but not sensory, neurons. IMPORTANCE Stress exacerbates acute disease symptoms resulting from HSV-1 and HSV-2 infections and is associated with the appearance of recurrent skin lesions in millions of people. Although stress hormones are thought to impact HSV-1 and HSV-2 through immune system suppression, sensory and autonomic neurons that become infected by HSV-1 and HSV-2 express stress hormone receptors and are responsive to hormone fluctuations. Our results show that autonomic neurons are more responsive to epinephrine and corticosterone than are sensory neurons, demonstrating that the autonomic nervous system plays a substantial role in HSV pathogenesis. Furthermore, these results suggest that stress responses have the potential to differentially impact HSV-1 and HSV-2 so as to produce divergent outcomes of infection. PMID:28404850

The Efficacy of a Repeated Buccal Infiltration of Articaine in Prolonging Duration of Pulpal Anesthesia in the Mandibular First Molar

PubMed Central

Pabst, Lindsay; Nusstein, John; Drum, Melissa; Reader, Al; Beck, Mike

2009-01-01

Previous studies have shown declining rates of pulpal anesthesia over 60 minutes when a cartridge of 4% articaine is used with 1∶100,000 epinephrine for buccal infiltration in the mandibular first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular first molar buccal infiltrations, given in 2 separate appointments, to 86 adult subjects: an initial infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine plus a repeated infiltration of the same anesthetic and dose given 25 minutes following the initial infiltration versus an initial infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine plus a mock repeated infiltration given 25 minutes following the initial infiltration. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 112 minutes after the injections. The repeated infiltration significantly improved pulpal anesthesia from 28 minutes through 109 minutes in the mandibular first molar. A repeated infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine given 25 minutes after an initial infiltration of the same type and dose of anesthetic significantly improved the duration of pulpal anesthesia, when compared with only an initial buccal infiltration, in the mandibular first molar. PMID:20020793

Oral Mucosal Injection of a Local Anesthetic Solution Containing Epinephrine Enhances Muscle Relaxant Effects of Rocuronium

PubMed Central

Ninomiya, Asako; Terakawa, Yui; Matsuura, Nobuyuki; Ichinohe, Tatsuya; Kaneko, Yuzuru

2012-01-01

The purpose of this study was to examine how submucosal injection of a clinically relevant dose of a lidocaine hydrochloride solution containing epinephrine affects the muscle relaxant effects of rocuronium bromide. Sixteen patients scheduled for orthognathic surgery participated in this study. All patients were induced with fentanyl citrate, a target-controlled infusion of propofol and rocuronium bromide. Anesthesia was maintained by total intravenous anesthesia. After nasotracheal intubation, an infusion of rocuronium bromide was started at 7 µg/kg/min, and the infusion rate was then adjusted to maintain a train of four (TOF) ratio at 10 to 15%. The TOF ratio just prior to oral mucosal injection of a 1% lidocaine hydrochloride solution containing 10 µg/mL epinephrine (LE) was taken as the baseline. TOF ratio was observed for 20 minutes, with 1-minute intervals following the start of injection. Mean epinephrine dose was 85.6 ± 18.6 µg and mean infusion rate of rocuronium bromide was 6.3 ± 1.6 µg/kg/min. TOF ratio began to decrease 2 minutes after the injection of LE, reached the minimum value at 3.1 ± 3.6% 12 minutes after the injection, and then began to recover. We conclude that oral mucosal injection of LE enhances the muscle relaxant effects of rocuronium bromide. PMID:22428970

Managing anaphylaxis in the office setting.

PubMed

Cingi, Cemal; Wallace, Dana; Bayar Muluk, Nuray; Ebisawa, Motohiro; Castells, Mariana; Şahin, Ethem; Altıntoprak, Niyazi

2016-07-01

Although the definition of anaphylaxis for clinical use may vary by professional health care organizations and individuals, the definition consistently includes the concepts of a serious, generalized or systemic, allergic or hypersensitivity reaction that can be life-threatening or even fatal. In this review, we presented the important topics in the treatment of anaphylaxis in the office setting. This review will discuss triggers and risk factors, clinical diagnosis, and management of anaphylaxis in the office setting. Anaphylaxis in the office setting is a medical emergency. It, therefore, is important to prepare for it, to have a posted, written anaphylaxis emergency protocol, and to rehearse the plan regularly. In this review, we presented the important steps in managing anaphylaxis in the office. Treatment of anaphylaxis should start with epinephrine administered intramuscularly at the first sign of anaphylaxis. Oxygen and intravenous fluids may be needed for moderate-to-severe anaphylaxis or anaphylaxis that is quickly developing or if the patient is unresponsive to the first injection of epinephrine. Antihistamine therapy is considered adjunctive to epinephrine, which mainly relieves itching and urticaria. Corticosteroids, with an onset of action of 4-6 hours, have no immediate effect on anaphylaxis. To prevent near-fatal and fatal reactions from anaphylaxis, the patient, the family, and the physician must remember to follow the necessary steps when treating anaphylaxis. In anaphylaxis, there is no absolute contraindication for epinephrine.

NTP Toxicology and Carcinogenesis Studies of l-Epinephrine Hydrochloride (CAS No. 55-31-2) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

PubMed

1990-03-01

l-Epinephrine, an endogenous neurotransmitter hormone, is widely used for the treatment of allergic and respiratory disorders. NTP Toxicology and Carcinogenesis studies of epinephrine hydrochloride were conducted by exposing groups of F344/N rats and B6C3F1 mice of each sex to an aerosol containing epinephrine hydrochloride for 14 days, 13 weeks, 15 months, or 2 years. During the 14-day and 13-week studies, control animals were exposed to dilute aerosols of hydrochloric acid (pH 2.8), whereas during the 15-month and 2-year studies, controls were exposed to aerosols of water. Genetic toxicology studies of epinephrine were conducted in Salmonella typhimurium and Chinese hamster ovary (CHO) cells. Fourteen-Day Studies: Rats and mice were exposed to 0 or 12.5-200 mg/m3 epinephrine hydrochloride. Deaths occurred in male rats exposed to 12.5 mg/m3 or more and in females exposed to 25 mg/m3 or more. Deaths of mice occurred at concentrations of 50 mg/m3 or higher. Compound-related clinical signs included an increased respiratory rate in all groups of epinephrine-exposed rats and mice. At higher concentrations (100 and 200 mg/m3), excessive lacrimation and dyspnea in rats and exaggerated visual and auditory reflexes in mice were observed. Thirteen-Week Studies: Rats and mice were exposed to 0 or 2.5-40 mg/m3 epinephrine hydrochloride. Deaths in rats and mice were not concentration related. Final mean body weights of chemically exposed and hydrochloric acid aerosol control rats and mice were generally similar. Increased respiratory rates were noted in rats and mice exposed to 40 mg/m3. Heart and adrenal gland weights of rats and mice and liver weights of mice exposed to 40 mg/m3 were greater than those of aerosol controls. Squamous metaplasia occurred in the respiratory epithelium of the nasal mucosa of rats and mice exposed to 40 mg/m3. Degenerative lesions of the laryngeal muscle were seen in male and female rats exposed to 20 or 40 mg/m3. Inflammation in the glandular stomach was seen in male and female mice exposed to 10, 20, and 40 mg/m3, and uterine atrophy was seen in 7/10 female mice exposed to 40 mg/m3. Two-year studies were conducted by exposing groups of 60 rats or each sex to 0, 1.5, or 5 mg/m3 epinephrine hydrochloride, 5 days per week for 103 weeks. Groups of 60 mice of each sex were exposed to 0, 1.5, or 3 mg/m3 epinephrine hydrochloride, 5 days per week for 104 weeks. Use of these exposure concentrations represented a departure from the usual practice of utilizing doses equivalent to one-half the maximum tolerated dose (MTD) and the MTD for 2-year carcinogenicity studies. Thus, although the dose levels exceeded maximum human therapeutic use levels (normalized to body weight and surface area), they were less than one-half the MTD. Fifteen-Month Studies: Results of hematologic analyses did not show compound-related changes. Absolute liver weights for exposed mice (3 mg/m3) and rats (5 mg/m3) and relative liver weights for exposed rats (5 mg/m3) were significantly lower than those for controls. The absolute kidney weights for mice exposed to 3 mg/m3 and the kidney weight to body weight ratio for male mice exposed to 3 mg/m3 were significantly lower than those for controls. No compound-related lesions were seen in rats or mice. Body Weights and Survival in the Two-Year Studies: Mean body weights and survival of exposed and control rats and mice were similar (survival, rats--male: control, 33/50; 1.5 mg/m3, 27/50; 5 mg/m3, 32/50; female: 32/50; 29/50; 30/50; mice--male: control, 33/50; 1.5 mg/m3, 34/50; 3 mg/m3, 36/50; female: 32/50; 35/50; 34/50). Nonneoplastic and Neoplastic Effects in the Two-Year Studies: Suppurative inflammation of the nasal mucosa, dilatation of the nasal glands (Bowman's and septal), and hyperplasia of the respiratory epithelium were seen at increased incidences in male rats exposed to 5 mg/m3 and in female rats exposed to 1.5 or 5 mg/m3. Hyaline degeneration of the olfactory epithelium in male mice and suppurative inflammation of the nasal passage and hyaline degeneration of the respiratory epithelium in female mice were increased in the 1.5 and 3 mg/m3 groups compared with controls. No neoplasms seen in these studies were considered related to chemical exposure. Genetic Toxicology: Salmonella gene mutation tests with l-epinephrine yielded negative results in strain TA100 in the presence of exogenous metabolic activation (S9) and equivocal results in the absence of S9. No mutagenic activity was observed in strains TA98, TA1535, or TA1537 with or without S9. The responses observed in the CHO cell assay for induction of sister chromatid exchanges were considered to be negative and equivocal in the presence and absence of S9 activation, respectively. l-Epinephrine did not induce chromosomal aberrations in CHO cells with or without S9. Conclusions: Under the conditions of these 2-year studies, no carcinogenic effects were observed in male or female F344/N rats exposed to aerosols containing 1.5 or 5 mg/m3 l-epinephrine hydrochloride for 2 years or in B6C3F1 mice exposed to 1.5 or 3 mg/m3 l-epinephrine hydrochloride for 2 years. However, these studies were considered to be inadequate studies of carcinogenic activity because the concentrations used, which were chosen to represent multiples of therapeutic doses, were considered too low for the animals to have received an adequate systemic challenge from the compound. Synonyms: adrenaline hydrochloride; 4-(1-hydroxy-2-(methylamino)ethyl)-1,2-benzenediol; (-)3,4-dihydroxy-a-((methylamino)methyl)benzyl alcohol hydrochloride; methylaminoethanol catechol hydrochloride Trade names for epinephrine formulations: Primatene®. Mist; Sus-Phrine®.; Epipen®.; Supravenin Hydrochloride®.; Bronkaid®.

The effect of propofol infusion with topical epinephrine on cochlear blood flow and hearing: An experimental study.

PubMed

Jang, Chul Ho; Cho, Yong Beom; Lee, Jun Sik; Kim, Geun Hyung; Jung, Won-Kyo; Pak, Sok Cheon

2016-12-01

Propofol is the most commonly used intravenous (IV) anesthetic agent and is associated with hypotension upon induction of anesthesia. Intravenous propofol infusion has several properties that may be beneficial to patients undergoing middle ear surgery. Topical application of concentrated epinephrine is a valuable tool for achieving hemostasis in the middle ear and during mastoid surgery. The purpose of the present study was to determine the effects of propofol infusion with topical epinephrine on cochlear blood flow (CBF) and hearing in rats. Twenty one male Sprague-Dawley rats were divided into three groups. The rate of intravenous infusion of propofol was 4-6 ml/kg/hour. The first group (control group, n = 7) was given IV infusion of phosphate buffered saline (PBS) with topical application of PBS in the round window. In study group A (n = 7), the effect of topical phosphate buffered saline with IV infusion of propofol on CBF and hearing was evaluated. In study group B (n = 7), additional effects of topical epinephrine with IV infusion of propofol on CBF and hearing were evaluated. The laser Doppler blood flowmeter, CBF, and the mean arterial blood pressure (MAP) were measured and analyzed. Additionally, hearing test using auditory brainstem response (ABR) was performed in both groups. In both groups, infusion of propofol induced a time-dependent decrease in MAP. Approximately 30 min after the start of the propofol infusion, the CBF started to decrease slowly. The decrease in CBF was significantly greater in the study group compared to the control group. The threshold was elevated in the study group relative to the control group. During middle ear surgery, use of IV infusion of propofol with topical epinephrine cotton ball or cottonoid application is not recommended. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block.

PubMed

El-Baradey, Ghada F; Elshmaa, Nagat S

2014-11-01

The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block. This is a prospective randomized controlled observer-blinded study. This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 μg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 μg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request. The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant. Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E. In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects.

Bupivacaine (Marcaine): an evaluation of its tissue and systemic toxicity in humans.

PubMed

Moore, D C; Mather, L E; Bridenbaugh, L D; Thompson, G E; Balfour, R I; Lysons, D F; Horton, W G

1977-01-01

In countries other than the U.S.A., dosages of bupivacaine have been limited to 100 mg without epinephrine and 150 mg with epinephrine. A review of 7,688 regional block procedures employing bupivacaine in concentrations of 0.25, 0.5, and 0.75%, and in dosages as high as 600 mg, indicated that such stringent restrictions: (1) are unwarranted, (2) make comparisons with other local anesthetic agents difficult, and (3) are in need of revision.

Standard object recognition memory and "what" and "where" components: Improvement by post-training epinephrine in highly habituated rats.

PubMed

Jurado-Berbel, Patricia; Costa-Miserachs, David; Torras-Garcia, Meritxell; Coll-Andreu, Margalida; Portell-Cortés, Isabel

2010-02-11

The present work examined whether post-training systemic epinephrine (EPI) is able to modulate short-term (3h) and long-term (24 h and 48 h) memory of standard object recognition, as well as long-term (24 h) memory of separate "what" (object identity) and "where" (object location) components of object recognition. Although object recognition training is associated to low arousal levels, all the animals received habituation to the training box in order to further reduce emotional arousal. Post-training EPI improved long-term (24 h and 48 h), but not short-term (3 h), memory in the standard object recognition task, as well as 24 h memory for both object identity and object location. These data indicate that post-training epinephrine: (1) facilitates long-term memory for standard object recognition; (2) exerts separate facilitatory effects on "what" (object identity) and "where" (object location) components of object recognition; and (3) is capable of improving memory for a low arousing task even in highly habituated rats.

[Protective effect of Helianthus annuus (sunflower) on myocardial infarction in New Zealand rabbit].

PubMed

Guardia-Espinoza, Edith; Herrera-Hurtado, Gianina Liseth del Carmen; Garrido-Jacobi, Saúl; Cárdenas-Peralta, Danitza; Martínez-Romero, Christian; Hernández-Figueroa, Pedro; Condori-Calizaya, Mary; La Barrera-Llacchua, Juan; Flores-Ángeles, Miguel

2015-01-01

Determine the protective effect of oil Helianthus annuus (Sunflower) on myocardial infarction induced by epinephrine in New Zealand rabbits. The rabbits were randomized into five groups (8 per group): blank, negative control, experimental 1 (10 mg / kg), experimental 2 (20 mg / kg) and three experimental (40 mg/ kg). Experimental groups 1, 2 and 3 received Helianthus annuus oil for two weeks. Epinephrine (2 mg/Kg) to the negative, Experimental Control 1, 2 and 3 groups was given over two consecutive days with an interval of 24 h after pretreatment with oil. Twenty four hours after the last administration, the rabbits were anesthetized and sacrificed. Serum troponin I and polymorphonuclear evaluated by .mu.m.sup.2. Significant difference between the negative control group and the experimental groups 1, 2 and 3 was found in the serum variables troponin I and polymorphonuclear by .mu.m.sup.2. Helianthus annuus oil at doses of 20 mg/kg has protective effect on myocardial infarction induced by epinephrine in New Zealand rabbits.

A majority of parents of children with peanut allergy fear using the epinephrine auto-injector.

PubMed

Chad, L; Ben-Shoshan, M; Asai, Y; Cherkaoui, S; Alizadehfar, R; St-Pierre, Y; Harada, L; Allen, M; Clarke, A

2013-12-01

Prompt epinephrine administration is crucial in managing anaphylaxis, but epinephrine auto-injectors (EAIs) are underutilized by patients and their families. Children with peanut allergy were recruited from the Allergy Clinics at the Montreal Children's Hospital, food allergy advocacy organizations and organizations providing products to allergic individuals. Parents of children who had been prescribed an EAI were queried on whether they were fearful of using it and on factors that may contribute to fear. A majority of parents (672/1209 = 56%) expressed fear regarding the use of the EAI. Parents attributed the fear to hurting the child, using the EAI incorrectly or a bad outcome. Parents whose child had longer disease duration or a severe reaction and parents who were satisfied with the EAI training or found it easy to use were less likely to be afraid. Families may benefit from simulation training and more education on the recognition and management of anaphylaxis. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Temperature dependence of electrical properties of mixture of exogenous neurotransmitters dopamine and epinephrine

NASA Astrophysics Data System (ADS)

Patki, Mugdha; Patil, Vidya

2016-05-01

Neurotransmitters are chemical messengers that support the communication between the neurons. In vitro study of exogenous neurotransmitters Dopamine and Epinephrine and their mixture, carried out to learn about their electrical properties being dielectric constant and conductivity amongst others. Dielectric constant and conductivity of the selected neurotransmitters are found to increase with temperature. As a result, the time constant of the system increases with temperature. This change leads to increase in the time taken by the synapse to transport the action potential. The correlation between physical properties of exogenous neurotransmitters and psychological and physiological behaviour of human being may be understood with the help of current study. The response time of Epinephrine is in microseconds whereas response time of Dopamine is in milliseconds. The response time for both the neurotransmitters and their mixture is found to be increasing with temperature indicating the symptoms such as depression, apathy, chronic fatigue and low physical energy with no desire to exercise the body, which are observed during the fever.

The use of the mandibular infiltration anesthetic technique in adults.

PubMed

Meechan, John G

2011-09-01

The author describes the use of the infiltration anesthetic technique to anesthetize mandibular teeth in adults and explores its mechanism of action. The author reviewed articles describing randomized controlled trials of the mandibular infiltration anesthetic technique in healthy participants. The author found that using the mandibular infiltration anesthetic technique can produce anesthesia in adult mandibular teeth. The success was dose dependent and the choice of anesthetic solution was significant; 4 percent articaine with 1:100,000 epinephrine was more effective than 2 percent lidocaine with 1:100,000 epinephrine. Combining buccal and lingual infiltrations increased success in the mandibular incisor region. The success of the mechanism of infiltration of anesthetic at the mandibular first molar appeared to depend on the mental foramen. The mandibular infiltration anesthetic technique is an effective method of anesthetizing mandibular incisors. Four percent articaine with epinephrine appears to be the preferred solution. The choice of anesthetic solution is important when using the infiltration anesthetic technique in the adult mandible.

Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study.

PubMed

Saatchi, Masoud; Khademi, Abbasali; Baghaei, Badri; Noormohammadi, Hamid

2015-01-01

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of buffered with nonbuffered 2% lidocaine with 1:80,000 epinephrine solution for inferior alveolar nerve (IAN) block in patients with mandibular posterior teeth experiencing symptomatic irreversible pulpitis. Eighty adult patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received 2 cartridges of either 2% lidocaine with 1:80,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:80,000 epinephrine with 0.18 mL sterile distilled water using conventional IAN block injections. Endodontic access preparation was initiated 15 minutes after injection. Lip numbness was required for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by the t, Mann-Whitney, and chi-square tests. The success rates were 62.5% and 47.5% for buffered and nonbuffered groups, respectively, with no significant differences between the two groups (P = .381). Buffering the 2% lidocaine with 1:80,000 epinephrine with 8.4% sodium bicarbonate did not improve the success of the IAN block in mandibular molars in patients with symptomatic irreversible pulpitis. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Platelet impedance adhesiometry: A novel technique for the measurement of platelet adhesion and spreading.

PubMed

Polgár, L; Soós, P; Lajkó, E; Láng, O; Merkely, B; Kőhidai, L

2018-06-01

Thrombogenesis plays an important role in today's morbidity and mortality. Antithrombotics are among the most frequently prescribed drugs. Thorough knowledge of platelet function is needed for optimal clinical care. Platelet adhesion is a separate subprocess of platelet thrombus formation; still, no well-standardized technique for the isolated measurement of platelet adhesion exists. Impedimetry is one of the most reliable, state-of-art techniques to analyze cell adhesion, proliferation, viability, and cytotoxicity. We propose impedimetry as a feasible novel method for the isolated measurement of 2 significant platelet functions: adhesion and spreading. Laboratory reference platelet agonists (epinephrine, ADP, and collagen) were applied to characterize platelet functions by impedimetry using the xCELLigence SP system. Platelet samples were obtained from 20 healthy patients under no drug therapy. Standard laboratory parameters and clinical patient history were also analyzed. Epinephrine and ADP increased platelet adhesion in a concentration-dependent manner, while collagen tended to have a negative effect. Serum sodium and calcium levels and age had a negative correlation with platelet adhesion induced by epinephrine and ADP, while increased immunoreactivity connected with allergic diseases was associated with increased platelet adhesion induced by epinephrine and ADP. ADP increased platelet spreading in a concentration-dependent manner. Impedimetry proved to be a useful and sensitive method for the qualitative and quantitated measurement of platelet adhesion, even differentiating between subgroups of a healthy population. This novel technique is offered as an important method in the further investigation of platelet function. © 2018 John Wiley & Sons Ltd.

Effects of tibial and humerus intraosseous administration of epinephrine in a cardiac arrest swine model.

PubMed

Beaumont, Ltc Denise; Baragchizadeh, Asal; Johnson, Charles; Johnson, Don

2016-01-01

Compare maximum concentration (Cmax), time to maximum concentration (Tmax), mean serum concentration of epinephrine, return of spontaneous circulation (ROSC), time to ROSC, and odds of survival relative to epinephrine administration by humerus intraosseous (HIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine cardiac arrest model. Prospective, between subjects, randomized experimental design. TriService Research Facility. Yorkshire-cross swine (n = 28). Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, a dose of 1 mg of epinephrine was administered by HIO, TIO, or the IV routes. Blood samples were collected over 4 minutes and analyzed by high-performance liquid chromatography tandem mass spectrometry. ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, and odds ratio. There was no significant difference in rate of the ROSC among the TIO, HIO, and IV groups (p > 0.05). There were significant differences in Cmax: the HIO group was significantly higher than the TIO group (p = 0.007), but no significant difference between the IV and HIO (p = 0.33) or the IV and TIO group (p = 0.060). The Tmax was significantly shorter for both the IV and HIO versus the TIO group (p < 0.05), but no difference between IV and HIO (p = 0.328). The odds of survival were higher in the HIO group compared to all other groups. The TIO and HIO provide rapid and reliable access to administer life-saving medications during cardiac arrest.

Risk factors for hypertensive attack during pheochromocytoma resection

PubMed Central

Kwon, Se Yun; Lee, Kyung Seop; Lee, Jun Nyung; Ha, Yun-Sok; Choi, Seock Hwan; Kim, Hyun Tae; Kim, Tae-Hwan; Yoo, Eun Sang

2016-01-01

Purpose We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge. Materials and Methods Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed. Results In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d. Conclusions In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma. PMID:27194549

Monitoring the Secretory Behavior of the Rat Adrenal Medulla by High-Performance Liquid Chromatography-Based Catecholamine Assay from Slice Supernatants

PubMed Central

De Nardi, Frédéric; Lefort, Claudie; Bréard, Dimitri; Richomme, Pascal; Legros, Christian; Guérineau, Nathalie C.

2017-01-01

Catecholamine (CA) secretion from the adrenal medullary tissue is a key step of the adaptive response triggered by an organism to cope with stress. Whereas molecular and cellular secretory processes have been extensively studied at the single chromaffin cell level, data available for the whole gland level are much scarcer. We tackled this issue in rat by developing an easy to implement experimental strategy combining the adrenal acute slice supernatant collection with a high-performance liquid chromatography-based epinephrine and norepinephrine (NE) assay. This technique affords a convenient method for measuring basal and stimulated CA release from single acute slices, allowing thus to individually address the secretory function of the left and right glands. Our data point that the two glands are equally competent to secrete epinephrine and NE, exhibiting an equivalent epinephrine:NE ratio, both at rest and in response to a cholinergic stimulation. Nicotine is, however, more efficient than acetylcholine to evoke NE release. A pharmacological challenge with hexamethonium, an α3-containing nicotinic acetylcholine receptor antagonist, disclosed that epinephrine- and NE-secreting chromaffin cells distinctly expressed α3 nicotinic receptors, with a dominant contribution in NE cells. As such, beyond the novelty of CA assays from acute slice supernatants, our study contributes at refining the secretory behavior of the rat adrenal medullary tissue, and opens new perspectives for monitoring the release of other hormones and transmitters, especially those involved in the stress response. PMID:28993760

Comparative Assessment of the Effects of Three Local Anesthetics: Lidocaine, Prilocaine, and Mepivacaine on Blood Pressure Changes in Patients with Controlled Hypertension.

PubMed

Hashemi, Seyyed Hamed Jalalian; Ladez, Shamsodin Rigi; Moghadam, Somaye Ansari

2016-10-01

Given large number of patients with hypertension attending dental clinics and the profound effects of local anesthetics containing vasoconstrictors, this study aimed to compare the effects of lidocaine 2% + epinephrine, prilocaine 3% + felypressin0.03, and mepivacaine 3% on blood pressure changes. The current study was carried out from May 2014 to February 2015.Patients with controlled hypertension (systolic blood pressure<159.94 mmHg before the injection) who attended Zahedan dental school (Zahedan , Iran) for the extraction of a mandibular tooth were selected and randomly allocated to three groups of 20. Groups 1-3 received lidocaine 2% + epinephrine, prilocaine 3% + felypressin 0.03 units, and mepivacaine3%, respectively. Patients were only included if they were injected with a maximum of two 1.8 ml cartridges (3.6 ml) for tooth extraction (maximum epinephrine dose of 0.04 mg was maintained in systemic patients).The collected data were analyzed using the analysis of variance (ANOVA) in SPSS 19.0. (SPSS Inc., Chicago, IL, USA)RESULTS: No significant differences were observed between the systolic and diastolic blood pressure of the three groups. The three evaluated local anesthetic solutions had similar effects in patients with controlled hypertension. While no significant changes in blood pressure were observed in three groups, all dental procedures on the mentioned group of patients have to be performed under careful monitoring and aspiration. Moreover, the maximum epinephrine dose (0.04mg) should never be exceeded in these patients.

[Beta-1 adrenoceptor blockade decreases the firing rate to painful stimuli in spinal wide-dynamic range neurons in rats].

PubMed

Lamothe-Molina, Paul J; Lamothe-Molina, Pedro A; López-Ávila, Alberto

2014-01-01

It is known that epinephrine/norepinephrine inhibit acute pain transmission. However, the role of ß-adrenoceptors is not clear. Thus, we analyzed if beta-1 and/or beta-2 adrenoceptors can modulate acute pain transmission by performing in vivo single unit recordings during painful and non-painful peripheral stimulation in rats. Longitudinal study in which we analyzed seven groups of male rats Wistar: control group (n = 11): saline (0.9 %); EPI group (n = 8): epinephrine 100 mcg; beta-1 agonist group (n = 8): dobutamine 125 mcg; beta-1-antagonist group (n = 9): metoprolol 100 mcg; beta-2-agonist group (n = 7): clenbuterol 100 mcg; beta-2-antagonist group (n = 8): butoxamine 100 mcg; beta-1-antagonist + EPI group (n = 10): metoprolol 100 mcg + epinephrine 100 mcg. For the statistical analysis we used ANOVA. Epinephrine significantly reduced the basal firing rate (BFR) in 34.1 % (p < 0.05) and also the evoked response by painful stimulation in 56 % (p < 0.05). No change was observed in the evoked response by non-painful stimulation. ANTß1 was the only beta-adrenoceptor acting drug that significantly reduced the evoked response by painful stimulation in 41 % (p < 0.05). None of the other drugs alone affected either the BFR or the evoked response to non-painful or painful stimulation. It is the first time that a beta-1-adrenoceptor antagonist (metoprolol) probes to be effective in reducing the response to painful stimulation in WDR neurons.

Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry

PubMed Central

Salciccioli, Justin D; Howell, Michael D; Cocchi, Michael N; Giberson, Brandon; Berg, Katherine; Gautam, Shiva; Callaway, Clifton

2014-01-01

Objective To determine if earlier administration of epinephrine (adrenaline) in patients with non-shockable cardiac arrest rhythms is associated with increased return of spontaneous circulation, survival, and neurologically intact survival. Design Post hoc analysis of prospectively collected data in a large multicenter registry of in-hospital cardiac arrests (Get With The Guidelines-Resuscitation). Setting We utilized the Get With The Guidelines-Resuscitation database (formerly National Registry of Cardiopulmonary Resuscitation, NRCPR). The database is sponsored by the American Heart Association (AHA) and contains prospective data from 570 American hospitals collected from 1 January 2000 to 19 November 2009. Participants 119 978 adults from 570 hospitals who had a cardiac arrest in hospital with asystole (55%) or pulseless electrical activity (45%) as the initial rhythm. Of these, 83 490 arrests were excluded because they took place in the emergency department, intensive care unit, or surgical or other specialty unit, 10 775 patients were excluded because of missing or incomplete data, 524 patients were excluded because they had a repeat cardiac arrest, and 85 patients were excluded as they received vasopressin before the first dose of epinephrine. The main study population therefore comprised 25 095 patients. The mean age was 72, and 57% were men. Main outcome measures The primary outcome was survival to hospital discharge. Secondary outcomes included sustained return of spontaneous circulation, 24 hour survival, and survival with favorable neurologic status at hospital discharge. Results 25 095 adults had in-hospital cardiac arrest with non-shockable rhythms. Median time to administration of the first dose of epinephrine was 3 minutes (interquartile range 1-5 minutes). There was a stepwise decrease in survival with increasing interval of time to epinephrine (analyzed by three minute intervals): adjusted odds ratio 1.0 for 1-3 minutes (reference group); 0.91 (95% confidence interval 0.82 to 1.00; P=0.055) for 4-6 minutes; 0.74 (0.63 to 0.88; P<0.001) for 7-9 minutes; and 0.63 (0.52 to 0.76; P<0.001) for >9 minutes. A similar stepwise effect was observed across all outcome variables. Conclusions In patients with non-shockable cardiac arrest in hospital, earlier administration of epinephrine is associated with a higher probability of return of spontaneous circulation, survival in hospital, and neurologically intact survival. PMID:24846323

The effects of adrenalectomy and corticsteroid injection on the fibrinolytic activity of complex heparin compounds in the blood during immobilization

NASA Technical Reports Server (NTRS)

Kudryashov, B. A.; Lomovskaya, E. G.; Shapiro, F. B.; Lyapina, L. Y.

1980-01-01

Total non-enzymatic fibrinolytic activity in the blood of rats increased three times in response to stress caused by 30 minute immobilization, and the activity of epinephrine-heparin complex increased nine times. In adrenalectomized animals, which showed a weak response to the same stress, intraperitoneal injection of hydrocortisone 30 minutes prior to immobilization normalized the response. Obtained results indicate that adrenalectomy leads to sharp reduction of heparin complexing with thromogenic proteins and epinephrine, while substitution therapy with hydrocortisone restores anticoagulation system function.

Caudal epidural anesthesia in mares after bicarbonate addition to a lidocaine-epinephrine combination.

PubMed

Duarte, Patricia C; Paz, Cahuê F R; Oliveira, Alvaro P L; Maróstica, Thairê P; Cota, Leticia O; Faleiros, Rafael R

2017-07-01

To investigate the nociceptive and clinical effects of buffering a lidocaine-epinephrine solution with sodium bicarbonate in caudal epidural block in mares. Prospective randomized controlled trial. Six mixed-breed mares weighing 350-440 kg. Each animal was administered two caudal epidural injections, 72 hours apart, using different solutions prepared immediately before injection. The control solution was 7 mL 2% lidocaine hydrochloride with epinephrine hemitartrate (1:200,000) added to 3 mL sterile water for injection (pH 2.9). The alkalinized solution was 7 mL of lidocaine-epinephrine solution added to 2.3 mL sterile water for injection and 0.7 mL 8.4% sodium bicarbonate (pH 7.4). Nociception was evaluated by response to skin pinching at 31 sites in the sacral region and around the perimeter of the anogenital area (distances of 10, 15 and 20 cm) before, and 5, 10 and 15 minutes after epidural injection, then every 15 minutes until the return of nociception in all evaluated sites. The onset and duration times, and intensity of ataxia (grades 0 to 3) were recorded. The paired t test was used to compare the onset and duration of anesthesia and ataxia (p<0.05). Alkalization of the solution resulted in significant decreases in the average time of onset of loss of nociception in the sacral region (40%) and around the perimeter of the anogenital area extending up to 5 cm (36%) and from 5 to 10 cm (32%) from the anus and vulva. Alkalization also decreased the average duration of ataxia (33%), without affecting the duration and extent of anesthesia or the degree of ataxia. Alkalization of lidocaine-epinephrine solution is advantageous in shortening the duration of ataxia and hastening the onset of anesthesia in areas adjacent to the anogenital area, without reducing the duration of epidural anesthesia, in mares. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study.

PubMed

Fernandes, Magda L; Pires, Kleber C C; Tibúrcio, Moacir A; Gomez, Renato S

2012-04-01

We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures. Eighty patients aged 1-10 years were prospectively enrolled. After the induction of general anesthesia, the patients were randomized to four caudal anesthesia groups: Group B (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000); Group BM (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg); Group BC (bupivacaine 0.166% with epinephrine 1:600,000 plus clonidine 1.0 μg/kg), and Group BMC (bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg and clonidine 1.0 μg/kg). Duration of surgery, emergence time, postoperative pain score measured by the face, legs, activity, cry, consolability (FLACC) scale, postoperative analgesia time, and overall use of rescue analgesics were recorded. The FLACC pain score (6, 12, and 24 h after the surgery) and the number of patients requiring analgesics during the first 24 h of the postoperative period were higher in Groups B and BC than in Groups BM and BMC (p < 0.05). The incidence of pruritus and urinary retention was comparable between the groups (p > 0.05). However, the incidence of postoperative nausea and vomiting (PONV) was higher in Groups BM (35%) and BMC (25%) than in Groups B (5%) and BC (5%) (p < 0.05). To conclude, we showed that 20 μg/kg of morphine added to caudal bupivacaine 0.166% plus epinephrine 1:600,000 decreased the use of analgesics in the postoperative period, although it was associated with an increased incidence of PONV. However, the addition of clonidine (1.0 μg/kg) to caudal bupivacaine provided no additional clinical benefit over bupivacaine alone.

Effect of cervical epidural blockade with 2% lidocaine plus epinephrine on respiratory function.

PubMed

Huang, Chih-Hung

2007-12-01

Cervical epidural anesthesia has been used widely for surgery of upper limbs. Although cervical epidural anesthesia with local anesthetic of 2% lidocaine (plain) has demonstrated the safety in respiratory function in spite of unavoidable phrenic and intercostal palsies to certain extent, the replacement of local anesthetics with 2% lidocaine plus epinephrine has not been investigated yet. I conducted this study to look into the effect of 2% lidocaine plus epinephrine on respiratory function. I collected data from 50 patients with mean age of 24 +/- 3 yrs, mean weight of 65 +/- 10 kg, ASA status: I-II without preoperative pulmonary dysfunction undergoing orthropedic open-reduction with internal fixation because of fractures of upper limbs. Cervical epidural space (C7-T1) was approached by hanging-drop method, using a 17G Tuohy needle. A catheter was inserted craniad to a distance of 12 cm. Pulmonary function measurement and arterial blood gas data were obstained before, 20 min, 50 min and 105 min after injection of 12 mL 2% lidocaine with 1:200,000 epinephrine. The anesthesia levels were between C3-T3 and obtained 15 +/- 2 min after injection. Mean arterial blood gas analysis showed mild respiratory acidosis at 20 min (PaCO2: 48 +/- 3 mmHg) and 50 min (PaCO2: 44 +/- 2 mmHg). The measured values of inspiratory vital capacity (IVC), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF) when compaired with control values, were decreased about 18.0% and 12.1% of the control values at 20 min and 50 min respectively. The ratios of FEV1/VC, FEV1/FVC were still within normal limits (> 80%). The results were significantly compatible with the criteria of mild restrictive type of pulmonary function. Cervical epidural anesthesia with 2% lidocaine plus epinephrine could reduce lung volumes and capacities, resulting from partially paralytic intercostal muscles and diaphragm innervated respectively by thoracic intercostal nerve and phrenic nerve. Without inadvertant total spinal or intravenous anesthesia or pre-existing pulmonary dysfunction, the patients with normal lungs could tolerate these changes well with the procedure.

Effect of local infiltration analgesia on post-operative pain following TVT-O: a double-blind, placebo-controlled randomized study.

PubMed

Tommaselli, Giovanni A; Di Carlo, Costantino; Formisano, Carmen; Fabozzi, Annamaria; Nappi, Carmine

2014-08-01

To evaluate the effect of a protocol of local anesthesia and epinephrine associated with sedo-analgesia on post-TVT-O pain in comparison with infiltration of saline and epinephrine. Forty-two patients undergoing TVT-O were randomized into two groups to receive periurethral infiltration with epinephrine only (group A, n = 21) or with epinephrine plus 1 % lidocaine hydrochloride (group B, n = 21). Post-operative pain was assessed using a visual analog scale (VAS) from 0 (absence of pain) to 10 (maximum pain possible), 1, 6, 12 and 24 h after the procedure. The total amount of analgesia was recorded and the proportion of women reporting a pain VAS score ≥4, 1 h after the procedure was calculated. ANOVA for repeated measures and Bonferroni correction, the Student's t test for independent samples, the Mann-Whitney U test, the Fisher exact test, or the χ (2) test for parametric was used. Pain level was significantly lower in group B 1 (p = 0.01) and 6 h (p = 0.05) after surgery, but not 12 and 24 h after the procedure. No significant difference was observed in the proportion of women requesting analgesia and in the total dosage of analgesics between the two groups. A significant higher proportion of women in group A reported a pain VAS score higher than four 1 h after surgery in comparison with patients in group B. This randomized study seems to indicate that systematic infiltration before TVT-O positioning with local anesthetic may reduce immediate post-operative pain.

GLUCOCORTICOID TREATMENT—EFFECT ON ADRENAL MEDULLARY CATECHOLAMINE PRODUCTION

PubMed Central

Sharara-Chami, Rana I.; Joachim, Maria; Pacak, Karel; Majzoub, Joseph A.

2016-01-01

Glucocorticoid and epinephrine are important stress hormones secreted from the adrenal gland during critical illness. Adrenal glucocorticoid stimulates phenylethanolamine N-methyltransferase (PNMT) to convert norepinephrine to epinephrine in the adrenal medulla. Glucocorticoid is sometimes used in catecholamine-resistant septic shock in critically ill patients. By suppressing adrenal glucocorticoid production, glucocorticoid therapy might also reduce the secretion of epinephrine during stress. To investigate this, we used a mouse model subjected to glucocorticoid therapy under basal conditions (experiment 1) and during stress (experiment 2). In experiment 1, pellets containing 0% to 8% dexamethasone were implanted subcutaneously in mice for 4 weeks. In experiment 2, animals received 14 days of intraperitoneal injections of normal saline, low- or high-dose dexamethasone, followed by 2 h of restraint. We found that in experiment 1, adrenal corticosterone did not differ with dexamethasone treatment. Phenylethanolamine N-methyltransferase messenger RNA levels and adrenal catecholamines were highest in the 8% dexamethasone group. Compared with experiment 1, restrained control mice in experiment 2 had high adrenal corticosterone, which decreased with dexamethasone. Phenylethanolamine N-methyltransferase messenger RNA content doubled with restraint but decreased with dexamethasone treatment. As in experiment 1, adrenal catecholamine content increased significantly with dexamethasone treatment. We conclude that without stress, when adrenocorticotropic hormone is low, high doses of exogenous dexamethasone stimulate PNMT and catecholamine synthesis, likely independently of adrenal corticosterone concentration. After stress, adrenocorticotropic hormone levels are elevated, and exogenous dexamethasone suppresses endogenous corticosterone and PNMT production. Nonetheless, catecholamines increase, possibly due to direct neural stimulation, which may override the hormonal regulation of epinephrine synthesis during stress. PMID:19503019

Excess nicotinamide inhibits methylation-mediated degradation of catecholamines in normotensives and hypertensives.

PubMed

Sun, Wu-Ping; Li, Da; Lun, Yong-Zhi; Gong, Xiao-Jie; Sun, Shen-Xia; Guo, Ming; Jing, Li-Xin; Zhang, Li-Bin; Xiao, Fu-Cheng; Zhou, Shi-Sheng

2012-02-01

Nicotinamide and catecholamines are both degraded by S-adenosylmethionine-dependent methylation. Whether excess nicotinamide affects the degradation of catecholamines is unknown. The aim of this study was to investigate the effect of nicotinamide on the methylation status of the body and methylation-mediated catecholamine degradation in both normotensives and hypertensives. The study was conducted in 19 normotensives and 27 hypertensives, using a nicotinamide-loading test (100 mg orally). Plasma nicotinamide, N(1)-methylnicotinamide, homocysteine (Hcy), betaine, norepinephrine, epinephrine, normetanephrine and metanephrine levels before and 5 h after nicotinamide loading were measured. Compared with normotensives, hypertensives had higher baseline (fasting) levels of plasma nicotinamide, Hcy and norepinephrine, but lower levels of plasma normetanephrine, a methylated norepinephrine derivative. Nicotinamide loading induced a significant increase in the levels of plasma N(1)-methylnicotinamide and norepinephrine, and a significant decrease in the levels of O-methylated epinephrine (metanephrine) and betaine, a major methyl donor, in both hypertensives and normotensives. Moreover, nicotinamide-loading significantly increased plasma Hcy levels, but decreased plasma normetanephrine levels in normotensives. The baseline levels of plasma epinephrine in hypertensives were similar to those of normotensives, but the post-nicotinamide-loading levels of plasma epinephrine in hypertensives were higher than those of normotensives. This study demonstrated that excess nicotinamide might deplete the labile methyl pool, increase Hcy generation and inhibit catecholamine degradation. It also revealed that hypertensives had an abnormal methylation pattern, characterized by elevated fasting plasma levels of unmethylated substrates, nicotinamide, Hcy and norepinephrine. Therefore, it seems likely that high nicotinamide intake may be involved in the pathogenesis of Hcy-related cardiovascular disease.

Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: A clinical study.

PubMed

Verma, Pushpendra Kumar; Srivastava, Ruchi; Ramesh, Kumar M

2013-03-01

The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis. To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed. Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation. Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate. Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: A clinical study

PubMed Central

Verma, Pushpendra Kumar; Srivastava, Ruchi; Ramesh, Kumar M

2013-01-01

Introduction: The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis. Aim: To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed. Materials and Methods: Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation. Results: Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate. Conclusions: Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:23716971

Adrenergic control of lipolysis in women compared with men

PubMed Central

Bessesen, Daniel H.; Stotz, Sarah; Peelor, Frederick F.; Miller, Benjamin F.; Horton, Tracy J.

2014-01-01

Data suggest women are more sensitive to the lipolytic action of epinephrine compared with men while maintaining similar glucoregulatory effects (Horton et al. J Appl Physiol 107: 200–210, 2009). This study aimed to determine the specific adrenergic receptor(s) that may mediate these sex differences. Lean women (n = 14) and men (n = 16) were studied on 4 nonconsecutive days during the following treatment infusions: saline (S: control), epinephrine [E: mixed β-adrenergic (lipolytic) and α2-adrenergic (antilipolytic) stimulation], epinephrine + phentolamine (E + P: mixed β-adrenergic stimulation only), and terbutaline (T: selective β2-adrenergic stimulation). Tracer infusions of glycerol, palmitate, and glucose were administered to determine systemic lipolysis, free fatty acid (FFA) release, and glucose turnover, respectively. Following basal measurements, substrate and hormone concentrations were measured in all subjects over 90 min of treatment and tracer infusion. Women had greater increases in glycerol and FFA concentrations with all three hormone infusions compared with men (P < 0.01). Glycerol and palmitate rate of appearance (Ra) and rate of disappearance (Rd) per kilogram body weight were greater with E infusion in women compared with men (P < 0.05), whereas no sex differences were observed with other treatments. Glucose concentration and kinetics were not different between sexes with any infusion. In conclusion, these data support the hypothesis that the greater rate of lipolysis in women with infusion of E was likely due to lesser α2 antilipolytic activation. These findings may help explain why women have greater lipolysis and fat oxidation during exercise, a time when epinephrine concentration is elevated. PMID:25190743

Anaphylaxis in the allergist's office: preparing your office and staff for medical emergencies.

PubMed

Wallace, Dana V

2013-01-01

All allergists who administer subcutaneous immunotherapy (SCIT) experience anaphylaxis in their offices and must devote proper planning, preparation, and practice to ensure that all staff members recognize the early signs and symptoms of anaphylaxis and can respond appropriately. Educating staff and patients, preparing an anaphylaxis emergency cart, developing and following selection criteria for SCIT and high-risk procedures, and customizing an "Action Plan for Anaphylaxis Management" create the foundation for mounting an adequate response to anaphylaxis. Strategies to prevent near-fatal and fatal reactions include (1) avoiding, when possible, the administration of SCIT to patients on beta-blockers; (2) using a preinjection questionnaire to review changes in the patient's medical condition, e.g., episodes of asthma since the previous injection; (3) using standardized forms and procedures for SCIT; (4) one might also consider an objective measure of airway function (e.g., peak flow measurement) for the asthmatic patient before allergy injections; (5) insisting on a 30-minute waiting time after SCIT; and (6) giving consideration to prescribing a dual-pack epinephrine autoinjector to all SCIT patients. Treatment of anaphylaxis should start with epinephrine administered intramuscularly at the first sign of anaphylaxis. Oxygen and i.v. fluids may be needed for moderate-to-severe anaphylaxis or anaphylaxis that is quickly developing or unresponsive to the first injection of epinephrine. Emergency medical services should be called for all patients who are experiencing moderate-to-severe (grade 2 or higher) anaphylaxis, if they require more than 1 dose of epinephrine and/or i.v. fluids, or if they do not immediately respond to treatment.

Prospective study of lidocaine, bupivacaine, and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty.

PubMed

Swanson, Eric

2012-09-01

Bupivacaine levels have not been measured in cosmetic surgery patients to establish safety. Blood loss has been underestimated using the small volumes present in the aspirate. The proportion of wetting solution removed by liposuction has not been reliably ascertained. To remedy these deficiencies, a prospective study was undertaken among 322 consecutive patients presenting for superwet ultrasonic liposuction and/or abdominoplasty, and other combined procedures, using infusions containing 0.05% lidocaine (liposuction) and/or 0.025% bupivacaine (abdominoplasty) with 1:500,000 epinephrine. Plasma levels of lidocaine, bupivacaine, and epinephrine were studied in a subset of 76 consecutive patients, including hourly intraoperative samples in 39 consecutive patients. Anesthetic levels were also measured in 12 consecutive patients during the 24-hour period after infusion. The maximum lidocaine dose was 3243 mg and the maximum level was 2.10 μg/ml. The maximum bupivacaine dose was 550 mg and the maximum level was 0.81 μg/ml. No clinical toxicity was encountered. Estimated blood loss from liposuction was 217.5 cc + 187 cc/liter of aspirate (r = 0.65). Abdominoplasty added 290 cc of blood loss, on average. The mean proportion of wetting solution removed by liposuction was 9.8 percent. Bupivacaine may be safely used in cosmetic surgery. A concentration of 1:500,000 epinephrine is safe and effective when administered as part of a wetting solution that is limited to less than 5 liters. Estimated blood loss is higher than previous estimates based on lipocrits. Combination procedures are safe.

Bupivacaine digital blocks: how long is the pain relief and temperature elevation?

PubMed

Calder, Kevin; Chung, Bryan; O'Brien, Cliona; Lalonde, Donald H

2013-05-01

The goals of this study are threefold: (1) to determine what effect epinephrine has on the duration of bupivacaine finger block anesthesia; (2) to see whether the duration of action of bupivacaine on digital pain relief is the same duration as numbness to touch/pressure; and (3) to assess the fingertip temperature changes that result from bupivacaine digital blocks. The ring fingers of both hands of 44 volunteers were randomized to injection of bupivacaine with or without 1:200,000 epinephrine. The durations of time for digits to return to normal pain, touch, pressure sensation, and fingertip temperature were measured and recorded. There were three main findings: (1) the pain block of bupivacaine lasts only half as long (15 hours) as the return to normal sensation (30 hours); (2) the effect of adding epinephrine to bupivacaine prolongs the duration of pain relief in a finger block for only an additional 1.5 hours; (3) in addition to pain relief, bupivacaine finger blocks cause fingertip hyperemia with consistent significant fingertip temperature elevation that lasts 15 hours. The duration of bupivacaine pain relief is the clinically important factor that needs to be reported in bupivacaine trials. Patients should be informed that the return of pain will occur much sooner than the return of normal sensation. Adding epinephrine to bupivacaine does not add a clinically significant length of time to pain relief. Bupivacaine finger blocks provide prolonged hyperemia and pain block to fingertips, which may be useful in the treatment of acute frostbite. Therapeutic, I.

Do stress responses promote leukemia progression? An animal study suggesting a role for epinephrine and prostaglandin-E2 through reduced NK activity.

PubMed

Inbar, Shelly; Neeman, Elad; Avraham, Roi; Benish, Marganit; Rosenne, Ella; Ben-Eliyahu, Shamgar

2011-04-29

In leukemia patients, stress and anxiety were suggested to predict poorer prognosis. Oncological patients experience ample physiological and psychological stress, potentially leading to increased secretion of stress factors, including epinephrine, corticosteroids, and prostaglandins. Here we tested whether environmental stress and these stress factors impact survival of leukemia-challenged rats, and studied mediating mechanisms. F344 rats were administered with a miniscule dose of 60 CRNK-16 leukemia cells, and were subjected to intermittent forced swim stress or to administration of physiologically relevant doses of epinephrine, prostaglandin-E(2) or corticosterone. Stress and each stress factor, and/or their combinations, doubled mortality rates when acutely applied simultaneously with, or two or six days after tumor challenge. Acute administration of the β-adrenergic blocker nadolol diminished the effects of environmental stress, without affecting baseline survival rates. Prolonged β-adrenergic blockade or COX inhibition (using etodolac) also increased baseline survival rates, possibly by blocking tumor-related or normal levels of catecholamines and prostaglandins. Searching for mediating mechanisms, we found that each of the stress factors transiently suppressed NK activity against CRNK-16 and YAC-1 lines on a per NK basis. In contrast, the direct effects of stress factors on CRNK-16 proliferation, vitality, and VEGF secretion could not explain or even contradicted the in vivo survival findings. Overall, it seems that environmental stress, epinephrine, and prostaglandins promote leukemia progression in rats, potentially through suppressing cell mediated immunity. Thus, patients with hematological malignancies, which often exhibit diminished NK activity, may benefit from extended β-blockade and COX inhibition.

Nannies' knowledge, attitude, and management of food allergies of children: an online survey.

PubMed

Greiwe, Justin C; Pazheri, Fouseena; Schroer, Brian

2015-01-01

Rates of food allergies in children as well as the rate of families who employ nannies have increased dramatically over the past decade. It is essential that nannies have the knowledge and tools necessary to recognize and treat food allergy reactions. To identify gaps in knowledge in the nanny population with regard to food allergy in children. A Web-based survey was sent by e-mail to 709 nannies. A total of 153 nannies (22%) completed the online survey: 26% of respondents had formal educational training at a nanny school; 99% recognized food allergy as a potentially fatal event; 37% reported caring for a child with food allergies. Of these, 71% had food allergy action plans, and 63% had epinephrine available. A total of 71% reported training on administering epinephrine. The nannies' major concerns included accidental ingestion and discomfort in administering epinephrine. A total of 36% were uncomfortable with recognizing a food allergy emergency, whereas 46% were uncomfortable administering epinephrine; 6% thought that a sensitized child could safely eat a small amount of allergenic food, whereas 14% believed that dilution with water might reduce an allergic reaction. A total of 66% desired additional information about recognizing food allergies, and 71% agreed that food allergy training should be required for all nannies. Nannies demonstrated gaps in knowledge with regard to food allergy in children, which reflects the need for more stringent training and education. Increased communication among parents, nannies, and physicians is needed to protect children with food allergy. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials.

PubMed

Su, Naichuan; Li, Chunjie; Wang, Hang; Shen, Jiefei; Liu, Wenjia; Kou, Liang

2016-04-01

The aim was to assess the efficacy and safety of articaine compared with lidocaine for irreversible pulpitis (IP) treatment. Databases were explored electronically and relevant journals as well as the references of the included studies were hand-searched for randomised clinical trials comparing the efficacy and safety of articaine with lidocaine in treatment of IP. Twenty studies were included, of which eight had low risk of bias, 10 had moderate risk of bias and two had high risk of bias. In comparison with 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine showed a higher success rate in anaesthesia of IP at either person (risk ratio (RR) 1.15; 95% confidence intervals (CI) 1.10 1.20; P < 0.00001) or tooth unit (RR 1.10; 95% CI 1.10 1.19, P < 0.00001), lower VAS scores during injection phase (mean difference (MD) -0.67; 95% CI -1.26 -0.08, P = 0.02) and treatment phase (MD -3.35; 95% CI -3.78 -2.91, P < 0.00001), shorter onset time of pulpal anaesthesia (MD -0.94; 95% CI -1.13 -0.74, P < 0.00001) and lower percentage of patients undergoing adverse events (RR 0.17; 95% CI 0.03 0.92, P = 0.04). Given the efficacy and safety of the two solutions, 4% articaine with 1:100,000 epinephrine was superior to 2% lidocaine with 1:100,000 epinephrine in dental treatments in IP. © 2016 Australian Society of Endodontology Inc.

International survey of knowledge of food-induced anaphylaxis

PubMed Central

Wang, Julie; Young, Michael C.; Nowak-Węgrzyn, Anna

2014-01-01

Background Studies show that anaphylaxis is under-recognized and epinephrine (adrenaline) is under-used by medical personnel as well as patients and their families. This study assesses the knowledge of food-induced anaphylaxis diagnosis and management across different populations of providers and caregivers and other interested respondents. Methods An online survey embedded in a case discussion food-induced anaphylaxis was distributed by Medscape to registered members. Results 7822 responders who started the activity chose to answer at least some of the questions presented (response rate 39.5%). Over 80% of responders in all groups correctly identified the case of anaphylaxis with prominent skin and respiratory symptoms, however, only 55% correctly recognized the case without skin symptoms as anaphylaxis. Only 23% of responders correctly selected risk factors for anaphylaxis, with physicians significantly more likely to choose the correct answers as compared to allied health, other health professionals and medical students (p<0.001). Ninety five perecnt selected epinephrine (adrenaline) as the most appropriate treatment for anaphylaxis, and 81% correctly indicated that there are no absolute contraindications for epinephrine (adrenaline) in the setting of anaphylaxis. When presented a case of a child with no documented history of allergies who has symptoms of anaphylaxis, more physicians than any other group chose to administer stock epinephrine (adrenaline) (73% vs 60%, p<0.001). Conclusion Specific knowledge deficits for food-induced anaphylaxis persist across all groups. Further educational efforts should be aimed not only at the medical community but also for the entire caregiver community and general public, to optimize care for food allergic individuals. PMID:25263184

Wilderness Medical Society practice guidelines for the use of epinephrine in outdoor education and wilderness settings: 2014 update.

PubMed

Gaudio, Flavio G; Lemery, Jay; Johnson, David E

2014-12-01

The Epinephrine Roundtable took place on July 27, 2008, during the 25th Annual Meeting of the Wilderness Medical Society (WMS) in Snowmass, CO. The WMS convened this roundtable to explore areas of consensus and uncertainty in the field treatment of anaphylaxis. Panelists were selected on the basis of their relevant academic or professional experience. There is a paucity of data that address the treatment of anaphylaxis in the wilderness. Anaphylaxis is a rare disease, with a sudden onset and drastic course that does not lend itself to study in randomized, controlled trials. Therefore, the panel endorsed the following position based on the limited available evidence and review of published articles, as well as expert consensus. The position represents the consensus of the panelists and is endorsed by the WMS. In 2014, the authors reviewed relevant articles published since the Epinephrine Roundtable. The following is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2010;21(4):185-187. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis.

PubMed

Bigby, Jason; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2006-11-01

The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The Stabident system was used to administer 1.8 ml of 4% articaine with 1:100,000 epinephrine. Success of the intraosseous injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 86% (32 of 37) of the patients. Maximum mean heart rate was increased 32 beats/minute during the intraosseous injection. We can conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

Effects of 2 different medetomidine infusion rates on selected neurohormonal and metabolic parameters in dogs

PubMed Central

Lamont, Leigh; Burton, Shelley; Caines, Deanne; Masaoud, Elmabrok; Troncy, Eric

2012-01-01

The effects of 2 different 8-hour continuous rate infusions (CRIs) of medetomidine on epinephrine, norepinephrine, cortisol, glucose, and insulin levels were investigated in 6 healthy dogs. Each dog received both treatments and a control as follows: MED1 = 2 μg/kg bodyweight (BW) loading dose followed by 1 μg/kg BW per hour CRI; MED2 = 4 μg/kg BW loading dose followed by 2 μg/kg BW per hour CRI; and CONTROL = saline bolus followed by a saline CRI. Both infusion rates of medetomidine decreased norepinephrine levels throughout the infusion compared to CONTROL. While norepinephrine levels tended to be lower with the MED2 treatment compared to the MED1, this difference was not significant. No differences in epinephrine, cortisol, glucose, or insulin were documented among any of the treatments at any time point. At the low doses used in this study, both CRIs of medetomidine decreased norepinephrine levels over the 8-hour infusion period, while no effects were observed on epinephrine, cortisol, glucose, and insulin. PMID:23024457

Comparison of intraosseous and infiltration injections for venous lidocaine blood concentrations and heart rate changes after injection of 2% lidocaine with 1:100,000 epinephrine.

PubMed

Wood, Mark; Reader, Al; Nusstein, John; Beck, Mike; Padgett, David; Weaver, Joel

2005-06-01

The purpose of this prospective, randomized study was to compare the venous blood levels of lidocaine and heart rate changes after intraosseous and infiltration injections of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. Using a crossover design, 20 subjects randomly received an intraosseous and infiltration injection at two separate appointments. The heart rate was measured using a pulse oximeter. Venous blood samples were collected before the injections and at 2, 5, 10, 15, 20, 25, 30, 45, and 60 min after the injections. The blinded plasma samples were analyzed for lidocaine concentrations using high-performance liquid chromatography (HPLC). The intraosseous injection resulted in a statistically significant increase in heart rate, when compared to the infiltration injection, during solution deposition and for 2 min after the injection. The plasma levels of lidocaine were not statistically different for maxillary anterior intraosseous and infiltration injections when using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine.

Comparison of the degree of pulpal anesthesia achieved with the intraosseous injection and infiltration injection using 2% lidocaine with 1:100,000 epinephrine.

PubMed

Nusstein, John; Wood, Mark; Reader, Al; Beck, Mike; Weaver, Joel

2005-01-01

This prospective, randomized study compared the degree of pulpal anesthesia obtained from an intraosseous injection to an infiltration injection that used 2% lidocaine with 1:100,000 epinephrine. The success rate for the intraosseous injection was 98%; for the infiltration injection, the success rate was 85%. There was no significant difference between the two techniques. The mean time for the onset of pulpal anesthesia was significantly faster with the intraosseous injection and the infiltration injection resulted in a significantly longer duration of pulpal anesthesia.

Articaine (4%) with epinephrine (1:100,000 or 1:200,000) in inferior alveolar nerve block: Effects on the vital signs and onset, and duration of anesthesia.

PubMed

Lasemi, Esshagh; Sezavar, Mehdi; Habibi, Leyla; Hemmat, Seyfollah; Sarkarat, Farzin; Nematollahi, Zahra

2015-12-01

This prospective, randomized, double-blind, clinical study was conducted to compare the effects of 4% articaine with 1:100,000 epinephrine (A100) and 4% articaine with 1:200,000 epinephrine (A200) on the vital signs and onset and duration of anesthesia in an inferior alveolar nerve block (IANB). In the first appointment, an IANB was performed by injecting A100 or A200 in 1 side of the mouth (right or left) randomly in patients referred for extraction of both their first mandibular molars. In the second appointment, the protocol was repeated and the other anesthetic solution was injected in the side that had not received the block in the previous session. Systolic and diastolic blood pressures (SBP and DBP) and pulse rate were measured during and 5 min after the injection. The onset and duration of anesthesia were also evaluated. Data were analyzed using t-test and Mann-Whitney U-test, and p-value was set at 0.05. SBP and pulse rate changes were slightly more with A100; however, DBP changes were more with A200, although the differences were not significant (P > 0.05). There were no statistically significant differences in the parameters evaluated in this study. The onset and duration of anesthesia, and the changes in SBP, DBP, and pulse rate during and 5 min after the injection were the same in both the groups. For an IANB, A200 and A100 were equally efficient and successful in producing the block. Epinephrine concentration did not influence the effects of 4% articaine.

Allergists' self-reported adherence to anaphylaxis practice parameters and perceived barriers to care: an American College of Allergy, Asthma, and Immunology member survey.

PubMed

Fineman, Stanley; Dowling, Paul; O'Rourke, Dianne

2013-12-01

Anaphylaxis is life-threatening and requires rapid medical intervention. Knowledge of treatment guidelines and addressing barriers to care are essential for appropriate management. To investigate allergists' self-reported practices in managing patients at risk for anaphylaxis, specifically in following practice parameters for diagnosis, treatment, and appropriate use of epinephrine, and to identify perceived barriers to care. Online questionnaires were distributed to members of the American College of Allergy, Asthma, and Immunology. The US physicians who self-identified as "allergist/immunologist" were eligible to participate. The first 500 completed questionnaires were analyzed. Nearly all (≥95%) reported adherence to practice parameters in prescribing an epinephrine auto-injector and instructing patients on its use, taking a detailed allergy history, counseling patients on avoidance measures, and educating patients on the signs and symptoms of anaphylaxis. More than 90% stated they determined the best diagnostic procedures to identify triggers and coordinated laboratory and allergy testing. Adherence to practice parameters was less robust for providing patients with written action plans and in-office anaphylaxis preparedness. Perceived barriers to care included a significant proportion of patients who were uncomfortable using epinephrine auto-injectors and inadequate knowledge of anaphylaxis among referral physicians. Allergists overwhelmingly adhere to practice parameter recommendations for the treatment and management of anaphylaxis, including appropriate use of epinephrine as first-line treatment, educating patients, and testing to diagnose anaphylaxis and identify its triggers. Opportunities for improvement include preparing staff and patients for anaphylactic events, providing written action plans, and improving knowledge of referring physicians. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Plasma variations in stress markers: Clinical trial of two anesthetics used in regional block in the extraction of impacted inferior third molars

PubMed Central

Arteagoitia, Iciar; Zumarraga, Mercedes; Dávila, Ricardo; Barbier, Luis; Santamaría, Gorka

2014-01-01

Objectives: Was to evaluate the effect of different regional anesthetics (articaine with epinephrine versus prilocaine with felypressin) on stress in the extraction of impacted lower third molars in healthy subjects. Sutdy Desing: A prospective single-blind, split-mouth cross-over randomized study was designed, with a control group. The experimental group consisted of 24 otherwise healthy male volunteers, with two impacted lower third molars which were surgically extracted after inferior alveolar nerve block (regional anesthesia), with a fortnight’s interval: the right using 4% articaine with 1:100.000 epinephrine, and the left 3% prilocaine with 1:1.850.000 felypressin. Patients were randomized for the first surgical procedure. To analyze the variation in four stress markers, homovanillic acid, 3-methoxy-4-hydroxyphenylglycol, prolactin and cortisol, 10-mL blood samples were obtained at t = 0, 5, 60, and 120 minutes. The control group consisted of 12 healthy volunteers, who did not undergo either extractions or anesthetic procedures but from whom blood samples were collected and analyzed in the same way. Results: Plasma cortisol increased in the experimental group (multiple range test, P<0.05), the levels being significantly higher in the group receiving 3% prilocaine with 1:1.850,000 felypressin (signed rank test, p<0.0007). There was a significant reduction in homovanillic acid over time in both groups (multiple range test, P<0.05). No significant differences were observed in homovanillic acid, 3-methoxy-4-hydroxyphenylglycol or prolactin concentrations between the experimental and control groups. Conclusions: The effect of regional anesthesia on stress is lower when 4% articaine with 1:100,000 epinephrine is used in this surgical procedure. Key words:Stress markets, epinephrine versus felypressin. PMID:24316704

Equivalent chemotherapy efficacy against leukemia in mice treated with topical vasoconstrictors to prevent cancer therapy side effects.

PubMed

Graul-Conroy, Amanda; Hicks, Emily J; Fahl, William E

2016-06-15

Topically applied vasoconstrictor is a new strategy to prevent oral mucositis and alopecia, two complications of chemotherapy and stem-cell transplant. We sought to determine whether mice treated with topical vasoconstrictor minutes before chemotherapy to suppress L1210 leukemia would develop a vasoconstrictor-induced L1210 cell sanctuary, and with it, significantly worse survival outcomes. B6D2F1 mice received 10(4) mouse L1210 leukemia cells via retro-orbital intravenous injection and were then divided into treatment groups, which included: (i) no further treatment, (ii) a single, sub-curative, intraperitoneal dose of cyclophosphamide (90 µg/gm bw) 24 hr after L1210 cell inoculation, (iii) topical epinephrine (25-400 mM) to clipped dorsal backs 20 min before cyclophosphamide or (iv) orotopical phenylephrine (16-130 mM), epinephrine (10 mM) or norepinephrine (25 mM) 20 min before cyclophosphamide. All mice were then followed until day of death. Differences in median survival time and percent survival between mice receiving cyclophosphamide alone and mice treated with either orotopical phenylephrine, epinephrine or norepinephrine; or topical epinephrine before cyclophosphamide were not significantly different. A discernible leukemia sanctuary was not created by topical vasoconstrictor treatment prior to chemotherapy; there was no significant difference in leukemia progression between untreated mice and those treated with either orotopical or topical vasoconstrictor before chemotherapy. We have opened a Phase I/IIa dose escalation trial to evaluate the safety and efficacy of orotopical phenylephrine in preventing oral mucositis in subjects undergoing hematopoietic stem cell transplant conditioning with cyclophosphamide plus total body irradiation. This could provide a cost-effective and convenient method to prevent oral mucositis. © 2016 UICC.

Anaphylaxis in Schools: Results of the EPIPEN4SCHOOLS Survey Combined Analysis.

PubMed

White, Martha V; Hogue, Susan L; Odom, Dawn; Cooney, Darryl; Bartsch, Jennifer; Goss, Diana; Hollis, Kelly; Herrem, Christopher; Silvia, Suyapa

2016-09-01

A pilot survey described the characteristics of anaphylactic events occurring in an initial set of participating U.S. schools during the 2013-2014 school year. This survey was subsequently readministered to large school districts, which were underrepresented in initial results. A cross-sectional survey was administered to the U.S. schools that were participating in the EPIPEN4SCHOOLS ® program (Mylan Specialty L.P., Canonsburg, PA) to assess characteristics of anaphylactic events. Data from large school districts were added to initial findings in this comprehensive combined analysis. A total of 1,140 anaphylactic events were reported among 6,574 responding schools. Of 1,063 anaphylactic events with data on who experienced the event, it was observed that it occurred mostly in students (89.5%, 951/1,063). For students, anaphylactic events were reported across all grades, with 44.9% (400/891) occurring in high school students, 18.9% (168/891) in middle school students, and 32.5% (290/891) in elementary school students. Food was identified as the most common trigger (60.1%, 622/1,035). A majority of schools (55.0%, 3,332/6,053) permitted only the school nurse and select staff to administer epinephrine to treat anaphylaxis. The unpredictability of anaphylaxis is emphasized by its high occurrence in individuals with no known allergies (25.0%). A majority of schools permitted only the school nurse and select staff to treat anaphylaxis. Thus, individuals experiencing an anaphylactic event may frequently encounter staff members not being permitted to administer potentially life-saving epinephrine. Epinephrine auto-injectors provided by the EPIPEN4SCHOOLS program were used to treat 38.0% of events. Anaphylaxis can occur in children with no previously known allergies, illustrating the importance of public access to epinephrine.

Kounis syndrome: a stinging case of ST-elevation myocardial infarction.

PubMed

Scherbak, Dmitriy; Lazkani, Mohamad; Sparacino, Nick; Loli, Akil

2015-04-01

Kounis syndrome is not a rare but an infrequently diagnosed non-thrombogenic cause of angina or myocardial infarction triggered by the release of inflammatory mediators following an allergic or anaphylactic reaction. This so-called "allergic angina" is seen in the setting of anaphylactic reactions and is believed to be due to mast cell release causing coronary vasospasm. The treatment of such cases is often with epinephrine, which has also been described in the literature as another rare cause of coronary vasospasm. We present a case of Kounis syndrome seen in a 46 year-old male who suffered two bee stings while landscaping in his yard. He developed an anaphylactic reaction and was promptly treated with IM epinephrine injection by paramedics at arrival and developed marked ST elevations on EKG in the inferior leads with reciprocal ST depressions in the anterior leads. His troponin peaked at 13 ng/mL and tryptase level was 15 ng/mL (normal <10 ng/mL). Coronary catheterisation showed non-diseased coronary arteries and a normal ejection fraction without evidence of vasospasm. He was afterwards treated with an epinephrine drip for distributive shock. Interestingly this syndrome was not provoked when re-challenged with this therapy, suggestive of an allergic reaction rather than epinephrine as the aetiology of his presumed vasospasm. This patient's ST segment elevation and troponin elevation was due to Kounis syndrome. Awareness that anaphylactic reactions can lead to Kounis syndrome can lead to prompt appropriate treatment for this life threatening condition. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mueller, R.M.M.; Martinez, J.R.

The uptake and efflux of the isotopic tracer /sup 45/Ca were compared in dispersed submandibular acini of both control rats and rats treated with seven daily doses of reserpine (0.5 mg/kg, i.p.). Tracer uptake occurred in a time-dependent manner in both types of acini and reached 8.4 +/- 0.2 and 8.0 +/- 0.2 pmol/mg protein, respectively, in acini from control and treated animals after 60 min of incubation. Uptake of tracer was 2.35 nmol/mg DNA in control cells and 4 nmol/mg DNA in cells from treated rats at 60 min. /sup 45/Ca uptake (per mg protein) was enhanced in controlmore » acini 48% by 20 mumol/L epinephrine; 38% by 50 mumol/L carbachol; and 23% by 10 mumol/L isoproterenol. A similar order of potency was observed when uptake was expressed per mg DNA. In acini from reserpine-treated rats, /sup 45/Ca uptake (per mg protein) was increased 53% by epinephrine, 39% by isoproterenol, and only 8% by carbachol. The same enhanced effect of isoproterenol and lack of effect of carbachol were observed when uptake was calculated per mg DNA. In the absence of secretagogue, efflux of /sup 45/Ca from tracer-pre-loaded acini was larger in acini from reserpine-treated rats (53%) than in control acini (36%). Whether expressed in terms of mg protein or mg DNA, this efflux was increased in control acini 35% by epinephrine, from 25 to 28% by isoproterenol, and 17% by carbachol. In acini of reserpine-treated rats, epinephrine increased /sup 45/Ca efflux 20%, isoproterenol from 25 to 28%, and carbachol from 14 to 15%.« less

Oral or intravenous proton pump inhibitor in patients with peptic ulcer bleeding after successful endoscopic epinephrine injection

PubMed Central

Tsai, Jai-Jen; Hsu, Yao-Chun; Perng, Chin-lin; Lin, Hwai-Jeng

2009-01-01

AIMS We aimed to assess the clinical effectiveness of oral vs. intravenous (i.v.) regular-dose proton pump inhibitor (PPI) after endoscopic injection of epinephrine in patients with peptic ulcer bleeding. METHODS Peptic ulcer patients with active bleeding, nonbleeding visible vessels, or adherent clots were enrolled after successful endoscopic haemostasis achieved by epinephrine injection. They were randomized to receive either oral rabeprazole (RAB group, 20 mg twice daily for 3 days) or i.v. omeprazole (OME group, 40 mg i.v. infusion every 12 h for 3 days). Subsequently, the enrolled patients receive oral PPI for 2 months (rabeprazole 20 mg or esomeprazole 40 mg once daily). The primary end-point was recurrent bleeding up to 14 days. The hospital stay, blood transfusion, surgery and mortality within 14 days were compared as well. RESULTS A total of 156 patients were enrolled, with 78 patients randomly allocated in each group. The two groups were well matched for factors affecting the clinical outcomes. Primary end-points (recurrent bleeding up to 14 days) were reached in 12 patients (15.4%) in the OME group and 13 patients (16.7%) in the RAB group [95% confidence interval (CI) of difference −12.82, 10.22]. All the rebleeding events occurred within 3 days of enrolment. The two groups were not different in hospital stay, volume of blood transfusion, surgery or mortality rate (1.3% of the OME group and 2.6% of the RAB group died, 95% CI of difference −5.6, 3.0). CONCLUSIONS Oral rabeprazole and i.v. regular-dose omeprazole are equally effective in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine. PMID:19523014

International consensus on (ICON) anaphylaxis

PubMed Central

2014-01-01

ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction. They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice. For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences. ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available. ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research. In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public. PMID:24920969

Catecholamines - urine

MedlinePlus

Dopamine - urine test; Epinephrine - urine test; Adrenalin - urine test; Urine metanephrine; Normetanephrine; Norepinephrine - urine test; Urine catecholamines; VMA; HVA; Metanephrine; Homovanillic ...

A New Flow Control Technique Using Diluted Epinephrine in the N-butyl-2-cyanoacrylate Embolization of Visceral Artery Pseudoaneurysms Secondary to Chronic Pancreatitis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp; Yamagami, Takuji; Takeuchi, Yoshito

2012-08-15

Although n-butyl-2-cyanoacrylate (NBCA) has been used as an effective liquid embolization material, its indication for pseudoaneurysms has seemingly been limited because of the technical difficulties of using NBCA, such as reflux to the parent artery and causing significant infarction. Thus, considerable skill in using NBCA or a device to control blood flow during its polymerization is required to achieve embolization without severe complications. We report our new technique for controlling blood flow using diluted epinephrine in transcatheter arterial NBCA embolization of five pseudoaneurysms in four cases secondary to hemosuccus pancreaticus.

Simultaneous voltammetric determination of dopamine and epinephrine in human body fluid samples using a glassy carbon electrode modified with nickel oxide nanoparticles and carbon nanotubes within a dihexadecylphosphate film.

PubMed

Figueiredo-Filho, Luiz C S; Silva, Tiago A; Vicentini, Fernando C; Fatibello-Filho, Orlando

2014-06-07

A simple and highly selective electrochemical method was developed for the single or simultaneous determination of dopamine (DA) and epinephrine (EP) in human body fluids using a glassy carbon electrode modified with nickel oxide nanoparticles and carbon nanotubes within a dihexadecylphosphate film using square-wave voltammetry (SWV) or differential-pulse voltammetry (DPV). Using DPV with the proposed electrode, a separation of ca. 360 mV between the peak reduction potentials of DA and EP present in binary mixtures was obtained. The analytical curves for the simultaneous determination of dopamine and epinephrine showed an excellent linear response, ranging from 7.0 × 10(-8) to 4.8 × 10(-6) and 3.0 × 10(-7) to 9.5 × 10(-6) mol L(-1) for DA and EP, respectively. The detection limits for the simultaneous determination of DA and EP were 5.0 × 10(-8) mol L(-1) and 8.2 × 10(-8) mol L(-1), respectively. The proposed method was successfully applied in the simultaneous determination of these analytes in human body fluid samples of cerebrospinal fluid, human serum and lung fluid.

Activation of Cyclic AMP Synthesis by Full and Partial Beta-Adrenergic Receptor Agonists in Chicken Skeletal Muscle Cells

NASA Technical Reports Server (NTRS)

Young, R. B.; Bridge, K. Y.

2003-01-01

Several beta-adrenergic receptor (bAR) agonists are known to cause hypertrophy of skeletal muscle tissue. Accordingly, five bAR agonists encompassing a range in activity from strong to weak were evaluated for their ability to stimulate CAMP accumulation in embryonic chicken skeletal muscle cells in culture. Two strong agonists (epinephrine and isoproterenol), one moderate agonist (albuterol), and two weak agonists known to cause hypertrophy in animals (clenbuterol and cimaterol) were studied. Dose response curves were determined over six orders of magnitude in concentration for each agonist, and values were determined for their maximum stimulation of CAMP synthesis rate (Bmax) and the agonist concentration at which 50% stimulation of CAMP synthesis (EC50) occurred. Bmax values decreased in the following order: isoproterenol, epinephrine, albuterol, cimaterol, clenbuterol. Cimaterol and clenbuterol at their Bmax concentrations were approximately 15-fold weaker than isoproterenol in stimulating the rate of CAMP synthesis. When cimaterol and clenbuterol were added to culture media at concentrations known to cause significant muscle hypertrophy in animals, there was no detectable effect on stimulation of CAMP synthesis. Finally, these same levels of cimaterol and clenbuterol did not antagonize the stimulation of CAMP by either epinephrine or isoproterenol.

The behavioral assessment and alleviation of pain associated with castration in beef calves treated with flunixin meglumine and caudal lidocaine epidural anesthesia with epinephrine

PubMed Central

Currah, Jan M.; Hendrick, Steven H.; Stookey, Joseph M.

2009-01-01

The objectives of this study were 1) to determine the effects of flunixin megulmine in combination with caudal epidural anesthesia as a postoperative analgesic in beef calves following surgical castration, and 2) to consider stride length and pedometry as potential behavioral assessment tools for detecting postcastration pain. Surgical castration was performed in 101 beef calves randomly assigned to 3 treatment subgroups: 1) castration without anesthesia (SURG); 2) castration following lidocaine with epinephrine caudal epidural anesthesia (SURG + EPI); 3) castration following lidocaine with epinephrine caudal epidural anesthesia and flunixin meglumine (SURG + EPI + F). Several outcomes, including pedometer counts, changes in stride length, subjective visual assessment of pain, instantaneous scan sampling of the calves’ postoperative activities, and the amount of movement and vocalization during the castration procedure, were measured to identify and quantify pain. The results indicated that stride length and the number of steps taken by calves after castration appear to be good measures of pain. Significant differences found between treatment groups for stride length and visual assessments suggest that flunixin meglumine can be considered to provide visible pain relief up to 8 hours postcastration. PMID:19436444

The behavioral assessment and alleviation of pain associated with castration in beef calves treated with flunixin meglumine and caudal lidocaine epidural anesthesia with epinephrine.

PubMed

Currah, Jan M; Hendrick, Steven H; Stookey, Joseph M

2009-04-01

The objectives of this study were 1) to determine the effects of flunixin megulmine in combination with caudal epidural anesthesia as a postoperative analgesic in beef calves following surgical castration, and 2) to consider stride length and pedometry as potential behavioral assessment tools for detecting postcastration pain. Surgical castration was performed in 101 beef calves randomly assigned to 3 treatment subgroups: 1) castration without anesthesia (SURG); 2) castration following lidocaine with epinephrine caudal epidural anesthesia (SURG + EPI); 3) castration following lidocaine with epinephrine caudal epidural anesthesia and flunixin meglumine (SURG + EPI + F). Several outcomes, including pedometer counts, changes in stride length, subjective visual assessment of pain, instantaneous scan sampling of the calves' postoperative activities, and the amount of movement and vocalization during the castration procedure, were measured to identify and quantify pain. The results indicated that stride length and the number of steps taken by calves after castration appear to be good measures of pain. Significant differences found between treatment groups for stride length and visual assessments suggest that flunixin meglumine can be considered to provide visible pain relief up to 8 hours postcastration.

Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients

PubMed Central

Nilsson, David; Sutton, Richard; Tas, Widet; Burri, Philippe; Melander, Olle; Fedorowski, Artur

2015-01-01

Background Impaired autonomic control of postural homeostasis results in orthostatic intolerance. However, the role of neurohormones in orthostatic intolerance has not been explained. Methods Six-hundred-and-seventy-one patients (299 males; 55±22 years) with unexplained syncope underwent head-up tilt (HUT) with serial blood sampling. Systolic blood pressure (SBP) and heart rate (HR) supine, after 3min, and lowest BP/highest HR during HUT were recorded. Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin (CT-proAVP), C-terminal- endothelin-1 (CT-proET-1), and mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP) were determined at supine and 3min of HUT. Multivariate-adjusted logistic regression model was applied to compare 1st (reference) with 4th quartile of 3 min and maximal ΔSBP/ΔHR (i.e. pronounced hypotension or tachycardia) vs. changes in neuroendocrine biomarkers, respectively. Results Higher resting CT-proET-1 predicted BP fall at 3min (Odds ratio (OR) per 1 SD: 1.62, 95%CI 1.18–2.22; p = 0.003), and max BP fall during HUT (1.82, 1.28–2.61; p = 0.001). Higher resting CT-proAVP predicted BP fall at 3min (1.33, 1.03–1.73; p = 0.03), which was also associated with increase in CT-proAVP (1.86, 1.38–2.51; p = 0.00005) and epinephrine (1.47, 1.12–1.92; p = 0.05) during HUT. Lower resting MR-proANP predicted tachycardia at 3min (0.37, 0.24–0.59; p = 0.00003), and max tachycardia during HUT (0.47, 0.29–0.77; p = 0.002). Further, tachycardia during HUT was associated with increase in epinephrine (1.60, 1.15–2.21; p = 0.005), and norepinephrine (1.87, 1.38–2.53; p = 0.005). Conclusions Resting CT-proET-1 and CT-proAVP are increased in orthostatic hypotension, while resting MR-proANP is decreased in postural tachycardia. Moreover, early BP fall during orthostasis evokes increase in CT-proAVP and epinephrine, while postural tachycardia is associated with increase in norepinephrine and epinephrine. PMID:26053073

Myocardial Drug Distribution Generated from Local Epicardial Application: Potential Impact of Cardiac Capillary Perfusion in a Swine Model Using Epinephrine

PubMed Central

Maslov, Mikhail Y.; Edelman, Elazer R.; Pezone, Matthew J.; Wei, Abraham E.; Wakim, Matthew G.; Murray, Michael R.; Tsukada, Hisashi; Gerogiannis, Iraklis S.; Groothuis, Adam; Lovich, Mark A.

2014-01-01

Prior studies in small mammals have shown that local epicardial application of inotropic compounds drives myocardial contractility without systemic side effects. Myocardial capillary blood flow, however, may be more significant in larger species than in small animals. We hypothesized that bulk perfusion in capillary beds of the large mammalian heart enhances drug distribution after local release, but also clears more drug from the tissue target than in small animals. Epicardial (EC) drug releasing systems were used to apply epinephrine to the anterior surface of the left heart of swine in either point-sourced or distributed configurations. Following local application or intravenous (IV) infusion at the same dose rates, hemodynamic responses, epinephrine levels in the coronary sinus and systemic circulation, and drug deposition across the ventricular wall, around the circumference and down the axis, were measured. EC delivery via point-source release generated transmural epinephrine gradients directly beneath the site of application extending into the middle third of the myocardial thickness. Gradients in drug deposition were also observed down the length of the heart and around the circumference toward the lateral wall, but not the interventricular septum. These gradients extended further than might be predicted from simple diffusion. The circumferential distribution following local epinephrine delivery from a distributed source to the entire anterior wall drove drug toward the inferior wall, further than with point-source release, but again, not to the septum. This augmented drug distribution away from the release source, down the axis of the left ventricle, and selectively towards the left heart follows the direction of capillary perfusion away from the anterior descending and circumflex arteries, suggesting a role for the coronary circulation in determining local drug deposition and clearance. The dominant role of the coronary vasculature is further suggested by the elevated drug levels in the coronary sinus effluent. Indeed, plasma levels, hemodynamic responses, and myocardial deposition remote from the point of release were similar following local EC or IV delivery. Therefore, the coronary vasculature shapes the pharmacokinetics of local myocardial delivery of small catecholamine drugs in large animal models. Optimal design of epicardial drug delivery systems must consider the underlying bulk capillary perfusion currents within the tissue to deliver drug to tissue targets and may favor therapeutic molecules with better potential retention in myocardial tissue. PMID:25234821

Effect of L-ornithine 8-vasopressin on blood loss during liposuction.

PubMed

Lalinde, E; Sanz, J; Ballesteros, A; Elejabeitia, J; Mesa, F; Bazán, A; Paloma, V

1995-06-01

In this comparative study, we carried out liposuction on 20 patients randomly divided in two groups to find an alternative medication to epinephrine that would not result in secondary effects at the cardiovascular level but would offer a similar vasoconstricting capacity. Also, a variation of the wet technique is described that decreases blood loss secondary to liposuction. The area to undergo liposuction is infiltrated with a cannula of our own design. Epinephrine is not used as a vasoconstrictor but rather L-ornithine 8-vasopressin at a concentration of 0.01 IU/ml chilled saline. With this new technique, the amount of blood removed is minimal, even in the case of extraction of large volumes of fat.

Alpha 2-adrenergic receptor stimulation of phospholipase A2 and of adenylate cyclase in transfected Chinese hamster ovary cells is mediated by different mechanisms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, S.B.; Halenda, S.P.; Bylund, D.B.

1991-02-01

The effect of alpha 2-adrenergic receptor activation on adenylate cyclase activity in Chinese hamster ovary cells stably transfected with the alpha 2A-adrenergic receptor gene is biphasic. At lower concentrations of epinephrine forskolin-stimulated cyclic AMP production is inhibited, but at higher concentrations the inhibition is reversed. Both of these effects are blocked by the alpha 2 antagonist yohimbine but not by the alpha 1 antagonist prazosin. Pretreatment with pertussis toxin attenuates inhibition at lower concentrations of epinephrine and greatly potentiates forskolin-stimulated cyclic AMP production at higher concentrations of epinephrine. alpha 2-Adrenergic receptor stimulation also causes arachidonic acid mobilization, presumably via phospholipasemore » A2. This effect is blocked by yohimbine, quinacrine, removal of extracellular Ca2+, and pretreatment with pertussis toxin. Quinacrine and removal of extracellular Ca2+, in contrast, have no effect on the enhanced forskolin-stimulated cyclic AMP production. Thus, it appears that the alpha 2-adrenergic receptor in these cells can simultaneously activate distinct signal transduction systems; inhibition of adenylate cyclase and stimulation of phospholipase A2, both via G1, and potentiation of cyclic AMP production by a different (pertussis toxin-insensitive) mechanism.« less

Stress hormone epinephrine (adrenaline) and norepinephrine (noradrenaline) effects on the anaerobic bacteria.

PubMed

Boyanova, Lyudmila

2017-04-01

Microbial endocrinology is a relatively new research area that already encompasses the anaerobes. Stress hormones, epinephrine and norepinephrine, can affect the growth of anaerobic bacteria such as Fusobacterium nucleatum, Prevotella spp., Porhyromonas spp., Tanerella forsythia and Propionibacterium acnes and can increase virulence gene expression, iron acquisition and many virulence factors of some anaerobic species such as Clostridium perfringens, Porphyromonas gingivalis and Brachyspira pilosicoli. Epinephrine and norepinephrine effects can lead to a growth increase or decrease, or no effect on the growth of the anaerobes. The effects are species-specific and perhaps strain-specific. Discrepancies in the results of some studies can be due to the different methods and media used, catecholamine concentrations, measurement techniques and the low number of strains tested. Biological effects of the stress hormones on the anaerobes may range from halitosis and a worsening of periodontal diseases to tissue damages and atherosclerotic plaque ruptures. Optimizations of the research methods and a detailed assessment of the catecholamine effects in conditions mimicking those in affected organs and tissues, as well as the effects on the quorum sensing and virulence of the anaerobes and the full spectrum of biological consequences of the effects are interesting topics for further evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pharmacology of pediatric resuscitation.

PubMed

Ushay, H M; Notterman, D A

1997-02-01

The resuscitation of children from cardiac arrest and shock remains a challenging goal. The pharmacologic principles underlying current recommendations for intervention in pediatric cardiac arrest have been reviewed. Current research efforts, points of controversy, and accepted practices that may not be most efficacious have been described. Epinephrine remains the most effective resuscitation adjunct. High-dose epinephrine is tolerated better in children than in adults, but its efficacy has not received full analysis. The preponderance of data continues to point toward the ineffectiveness and possible deleterious effects of overzealous sodium bicarbonate use. Calcium chloride is useful in the treatment of ionized hypocalcemia but may harm cells that have experienced asphyxial damage. Atropine is an effective agent for alleviating bradycardia induced by increased vagal tone, but because most bradycardia in children is caused by hypoxia, improved oxygenation is the intervention of choice. Adenosine is an effective and generally well-tolerated agent for the treatment of supraventricular tachycardia. Lidocaine is the drug of choice for ventricular dysrhythmias, and bretylium, still relatively unexplored, is in reserve. Many pediatricians use dopamine for shock in the postresuscitative period, but epinephrine is superior. Most animal research on cardiac arrest is based on models with ventricular fibrillation that probably are not reflective of cardiac arrest situations most often seen in pediatrics.

Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty.

PubMed

Meneghini, R Michael; Bagsby, Deren; Ireland, Philip H; Ziemba-Davis, Mary; Lovro, Luke R

2017-01-01

Liposomal bupivacaine has gained popularity for pain control after total knee arthroplasty (TKA), yet its true efficacy remains unproven. We compared the efficacy of two different periarticular injection (PAI) techniques for liposomal bupivacaine with a conventional PAI control group. This retrospective cohort study compared consecutive patients undergoing TKA with a manufacturer-recommended, optimized injection technique for liposomal bupivacaine, a traditional injection technique for liposomal bupivacaine, and a conventional PAI of ropivacaine, morphine, and epinephrine. The optimized technique utilized a smaller gauge needle and more injection sites. Self-reported pain scores, rescue opioids, and side effects were compared. There were 41 patients in the liposomal bupivacaine optimized injection group, 60 in the liposomal bupivacaine traditional injection group, and 184 in the conventional PAI control group. PAI liposomal bupivacaine delivered via manufacturer-recommended technique offered no benefit over PAI ropivacaine, morphine, and epinephrine. Mean pain scores and the proportions reporting no or mild pain, time to first opioid, and amount of opioids consumed were not better with PAI liposomal bupivacaine compared with PAI ropivacaine, morphine, and epinephrine. The use of the manufacturer-recommended technique for PAI of liposomal bupivacaine does not offer benefit over a conventional, less expensive PAI during TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Blood flow-independent accumulation of cisplatin in the guinea pig cochlea.

PubMed

Miettinen, S; Laurell, G; Andersson, A; Johansson, R; Laurikainen, E

1997-01-01

Considerable interindividual variability in the ototoxic effect of cisplatin has become the unpredictable dose-limiting factor in its use as curative as well as palliative therapy. The drug accumulates in highly vascular areas in the cochlea, causing dose-related hair cell loss. The purpose of this study was to assess blood flow-dependent aspects of cisplatin absorption in the cochlea in order to better understand factors that may influence cisplatin-induced ototoxicity. The effect of reduced cochlear blood flow on the ototoxic action of cisplatin was studied in guinea pigs. Before cisplatin administration the cochlear vasculature in each animal was unilaterally pre-constricted, by the application of 2% epinephrine to the round window. A 20-30% reduction in cochlear blood flow, assessed by laser Doppler flowmetry, was maintained before and after intravenous infusion of 0.1% cisplatin. Cisplatin infusion affected cochlear blood flow but not vessel conductivity. The cochlear blood flow decrease, maintained by local epinephrine application to the round window during cisplatin infusion, did not alter the cisplatin-induced hearing loss. In addition, the concentration of free cisplatin in scala tympani perilymph did not differ between epinephrine-treated and non-treated ears. Our results indicate that cisplatin transport into the cochlea is not an energy-dependent process in the lateral wall vasculature.

Activation of Cyclic AMP Synthesis by Full and Partial Beta-Adrenergic Receptor Agonists in Chicken Skeletal Muscle Cells

NASA Technical Reports Server (NTRS)

Young, R. B.; Bridge, K. Y.; Cureri, Peter A. (Technical Monitor)

2002-01-01

Several beta-adrenergic receptor (bAR) agonists are known to cause hypertrophy of skeletal muscle tissue. Accordingly, five bAR agonists encompassing a range in activity from strong to weak were evaluated for their ability to stimulate cAMP accumulation in embryonic chicken skeletal muscle cells in culture. Two strong agonists (epinephrine and isoproterenol), one moderate agonist (albuterol), and two weak agonists known to cause hypertrophy in animals (clenbuterol and cimaterol) were studied. Dose response curves were determined over six orders of magnitude in concentration for each agonist, and values were determined for their maximum stimulation of cAMP synthesis rate (Bmax) and the agonist concentration at which 50% stimulation of cAMP synthesis (EC50) occurred. Bmax values decreased in the following order: isoproterenol, epinephrine, albuterol, cimaterol, clenbuterol. Cimaterol and clenbuterol at their Bmax concentrations were approximately 15-fold weaker than isoproterenol in stimulating the rate of cAMP synthesis. When cimaterol and clenbuterol were added to culture media at concentrations known to cause significant muscle hypertrophy in animals, there was no detectable effect on stimulation of cAMP synthesis. Finally, these same levels of cimaterol and clenbuterol did not antagonize the stimulation of cAMP by either epinephrine or isoproterenol.

RAAS and stress markers in acute ischemic stroke: preliminary findings.

PubMed

Back, C; Thiesen, K L; Skovgaard, K; Edvinsson, L; Jensen, L T; Larsen, V A; Iversen, H K

2015-02-01

Angiotensin II type 1 receptor blockade has neuroprotective effects in animal stroke models, but no effects in clinical stroke trials. We evaluated cerebral and peripheral changes in the renin angiotensin aldosterone system (RAAS) and stress responses in acute ischemic stroke patients. Blood from a jugular and cubital vein was collected within 48 h of stroke onset, after 24 and 48 h, and renin, angiotensin I, angiotensin II, aldosterone, norepinephrine, epinephrine, and cortisol were measured. Post-stroke cubital vein samples were collected after 8 (4.7-10) months. The acute systolic blood pressure was significantly increased, 148 (141-168) vs 140 (130-147) mmHg post-stroke. Angiotensin I, renin and aldosterone levels were significantly lower, angiotensin II was unchanged, and ACE activity was higher in the acute phase compared to post-stroke. No differences in RAAS were detected between jugular and cubital plasma levels. Jugular venous plasma levels of epinephrine and cortisol were elevated in the acute phase compared to cubital levels (P < 0.05). Increased epinephrine and cortisol levels in the jugular vein blood may reflect a higher peripheral turnover. The observed changes in RAAS in the acute stroke phase are consistent with responses to increased blood pressure. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Drug-device combination products in the twenty-first century: epinephrine auto-injector development using human factors engineering.

PubMed

Edwards, Eric S; Edwards, Evan T; Simons, F Estelle R; North, Robert

2015-05-01

The systematic application of human factors engineering (HFE) principles to the development of drug-device combination products, including epinephrine auto-injectors (EAIs), has the potential to improve the effectiveness and safety of drug administration. A PubMed search was performed to assess the role of HFE in the development of drug-device combination products. The following keywords were used in different combinations: 'human factors engineering,' 'human factors,' 'medical products,' 'epinephrine/adrenaline auto-injector,' 'healthcare' and 'patient safety.' This review provides a summary of HFE principles and their application to the development of drug-device combination products as advised by the US FDA. It also describes the HFE process that was applied to the development of Auvi-Q, a novel EAI, highlighting specific steps that occurred during the product-development program. For drug-device combination products, device labeling and usability are critical and have the potential to impact clinical outcomes. Application of HFE principles to the development of drug-delivery devices has the potential to improve product quality and reliability, reduce risk and improve patient safety when applied early in the development process. Additional clinical and real-world studies will confirm whether the application of HFE has helped to develop an EAI that better meets the needs of patients at risk of anaphylaxis.

Efficacy and pharmacokinetics of bupivacaine with epinephrine or dexmedetomidine after intraperitoneal administration in cats undergoing ovariohysterectomy.

PubMed

Benito, Javier; Monteiro, Beatriz; Beaudry, Francis; Steagall, Paulo

2018-04-01

The aim of this study was to determine the efficacy and pharmacokinetics of bupivacaine in combination with epinephrine or dexmedetomidine after intraperitoneal administration in cats undergoing ovariohysterectomy. Sixteen healthy adult cats (3.3 ± 0.6 kg) were included in a prospective, randomized, masked clinical trial after obtaining owners' consent. Anesthetic protocol included buprenorphine-propofol-isoflurane. Meloxicam [0.2 mg/kg body weight (BW)] was administered subcutaneously before surgery. Cats were randomly divided into 2 groups to receive 1 of 2 treatments. Intraperitoneal bupivacaine 0.25% (2 mg/kg BW) was administered with epinephrine (BE group; 2 μg/kg BW) or dexmedetomidine (BD group; 1 μg/kg BW) before ovariohysterectomy ( n = 8/group). A catheter was placed in the jugular vein for blood sampling. Blood samples were collected for up to 8 h after bupivacaine was administered. Plasma concentrations and pharmacokinetics of bupivacaine were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS) and non-compartmental model, respectively. Pain was evaluated using the UNESP-Botucatu multidimensional composite pain scale (MCPS), the Glasgow composite feline pain scale (GPS), and a dynamic visual analog scale up to 8 h after extubation. Rescue analgesia was provided with buprenorphine if MCPS was ≥ 6. Repeated measures linear models were used for analysis of pain and sedation scores ( P < 0.05). Maximum bupivacaine plasma concentrations (Cmax) for BE and BD were 1155 ± 168 ng/mL and 1678 ± 364 ng/mL ( P = 0.29) at 67 ± 13 min (Tmax) and 123 ± 59 min ( P = 0.17), respectively. Pharmacokinetic parameters and pain scores were not different between treatments ( P > 0.05). One cat in the BE group received rescue analgesia ( P = 0.30). Intraperitoneal bupivacaine with epinephrine or dexmedetomidine produced concentrations below toxic levels and similar analgesic effects. It is therefore safe to administer these drug combinations in cats undergoing ovariohysterectomy.

Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest.

PubMed

Friess, Stuart H; Sutton, Robert M; Bhalala, Utpal; Maltese, Matthew R; Naim, Maryam Y; Bratinov, George; Weiland, Theodore R; Garuccio, Mia; Nadkarni, Vinay M; Becker, Lance B; Berg, Robert A

2013-12-01

During cardiopulmonary resuscitation, adequate coronary perfusion pressure is essential for establishing return of spontaneous circulation. Current American Heart Association guidelines recommend standardized interval administration of epinephrine for patients in cardiac arrest. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus chest compression depth-directed cardiopulmonary resuscitation in a porcine model of cardiac arrest. Randomized interventional study. Preclinical animal laboratory. Twenty-four 3-month-old female swine. After 7 minutes of ventricular fibrillation, pigs were randomized to receive one of three resuscitation strategies: 1) Hemodynamic directed care (coronary perfusion pressure-20): chest compressions with depth titrated to a target systolic blood pressure of 100 mm Hg and titration of vasopressors to maintain coronary perfusion pressure greater than 20 mm Hg; 2) Depth 33 mm: target chest compression depth of 33 mm with standard American Heart Association epinephrine dosing; or 3) Depth 51 mm: target chest compression depth of 51 mm with standard American Heart Association epinephrine dosing. All animals received manual cardiopulmonary resuscitation guided by audiovisual feedback for 10 minutes before first shock. Forty-five-minute survival was higher in the coronary perfusion pressure-20 group (8 of 8) compared to depth 33 mm (1 of 8) or depth 51 mm (3 of 8) groups; p equals to 0.002. Coronary perfusion pressures were higher in the coronary perfusion pressure-20 group compared to depth 33 mm (p = 0.004) and depth 51 mm (p = 0.006) and in survivors compared to nonsurvivors (p < 0.01). Total epinephrine dosing and defibrillation attempts were not different. Hemodynamic directed resuscitation targeting coronary perfusion pressures greater than 20 mm Hg during 10 minutes of cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest improves short-term survival, when compared to resuscitation with depth of compressions guided to 33 mm or 51 mm and standard American Heart Association vasopressor dosing.

Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn's disease and irritable bowel syndrome.

PubMed

Pellissier, Sonia; Dantzer, Cécile; Mondillon, Laurie; Trocme, Candice; Gauchez, Anne-Sophie; Ducros, Véronique; Mathieu, Nicolas; Toussaint, Bertrand; Fournier, Alicia; Canini, Frédéric; Bonaz, Bruno

2014-01-01

Crohn's disease (CD) and irritable bowel syndrome (IBS) involve brain-gut dysfunctions where vagus nerve is an important component. The aim of this work was to study the association between vagal tone and markers of stress and inflammation in patients with CD or IBS compared to healthy subjects (controls). The study was performed in 73 subjects (26 controls, 21 CD in remission and 26 IBS patients). The day prior to the experiment, salivary cortisol was measured at 8:00 AM and 10:00 PM. The day of the experiment, subjects completed questionnaires for anxiety (STAI) and depressive symptoms (CES-D). After 30 min of rest, ECG was recorded for heart rate variability (HRV) analysis. Plasma cortisol, epinephrine, norepinephrine, TNF-alpha and IL-6 were measured in blood samples taken at the end of ECG recording. Compared with controls, CD and IBS patients had higher scores of state-anxiety and depressive symptomatology. A subgroup classification based on HRV-normalized high frequency band (HFnu) as a marker of vagal tone, showed that control subjects with high vagal tone had significantly lower evening salivary cortisol levels than subjects with low vagal tone. Such an effect was not observed in CD and IBS patients. Moreover, an inverse association (r =  -0.48; p<0.05) was observed between the vagal tone and TNF-alpha level in CD patients exclusively. In contrast, in IBS patients, vagal tone was inversely correlated with plasma epinephrine (r =  -0.39; p<0.05). No relationship was observed between vagal tone and IL-6, norepinephrine or negative affects (anxiety and depressive symptomatology) in any group. In conclusion, these data argue for an imbalance between the hypothalamus-pituitary-adrenal axis and the vagal tone in CD and IBS patients. Furthermore, they highlight the specific homeostatic link between vagal tone and TNF-alpha in CD and epinephrine in IBS and argue for the relevance of vagus nerve reinforcement interventions in those diseases.

Local infiltration of the surgical wound with levobupivacaine, ibuprofen, and epinephrine in postoperative pain: An experimental study.

PubMed

Korat, Prashant S; Kapupara, Pankaj P

2017-12-01

The body areas from where sutures are removed later, where wound healing is delayed. Epidural analgesia is the most effective method but could not be used for postoperative pain. Peripheral nerve blockers also provided excellent analgesia but are not effective in postoperative pain. Infiltration of the surgical wound with local anesthetics is decreased postoperative pain by inhibiting transmission of noxious impulses at the site. The objective of the study was to explore the effect of the local infiltration of the surgical wounds with low-dose of levobupivacaine, ibuprofen, and epinephrine over the sutured muscle wound in postoperative pain. Laparotomy was performed in adult rats under isoflurane anesthesia. During surgery, the surgical wounds were infiltrated with 50μL solution containing 0.3% w/v levobupivacaine, 2mg/mL ibuprofen, and 8mg/mL epinephrine (treatment group) and compared to infiltration of that of water for injection (vehicle group) over the sutured muscle wound before skin closing. Postoperative pain was assessed by rodent grimace scales scoring. The study also carried out for measurement for histopathological examinations and the tensile strength of wound. The one-way ANOVA following the Dunnett Multiple comparisons test was used to show significant differences between parameters at 95% level of confidence. The fall in pain started with three-hour post-surgery in the treatment group. At 24h after the end of the successful infiltration, the treatment group had significant reduction of a pain than vehicle group (p=0.048; q=3.527). After three weeks of the wound were closed, a significant improvement of angiogenesis process (p=0.021) and the tensile strength (p=0.019) for the treatment group as compared to baseline. The experimental study was reported that local infiltration of the surgical wound with levobupivacaine, ibuprofen, and epinephrine combination was effective in the postoperative pain and healing of the surgical wounds. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The role of stress hormones in the relationship between resting blood pressure and coagulation activity.

PubMed

Wirtz, Petra H; Ehlert, Ulrike; Emini, Luljeta; Rüdisüli, Katharina; Groessbauer, Sara; Mausbach, Brent T; von Känel, Roland

2006-12-01

Systemic hypertension confers a hypercoagulable state. We hypothesized that resting mean blood pressure (MBP) interacts with stress hormones in predicting coagulation activity at rest and with acute mental stress. We measured plasma clotting factor VII activity (FVII:C), FVIII:C, fibrinogen, D-dimer, epinephrine and norepinephrine, and saliva cortisol in 42 otherwise healthy normotensive and hypertensive medication-free men (mean age 43 +/- 14 years) at rest, immediately after stress, and twice during 60 min of recovery from stress. At rest, the MBP-by-epinephrine interaction predicted FVII:C (beta = -0.33, P < 0.04) and D-dimer (beta = 0.26, P < 0.05), and the MBP-by-cortisol interaction predicted D-dimer (beta = 0.43, P = 0.001), all independent of age and body mass index (BMI). Resting norepinephrine predicted fibrinogen (beta = 0.42, P < 0.01) and D-dimer (beta = 0.37, P < 0.03), both independent of MBP. MBP predicted FVIII:C change from rest to immediately post-stress independent of epinephrine (beta = -0.37, P < 0.03) and norepinephrine (beta = -0.38, P < 0.02). Cortisol change predicted FVIII:C change (beta = -0.30, P < 0.05) independent of age, BMI and MBP. Integrated norepinephrine change from rest to recovery (area under the curve, AUC) predicted D-dimer AUC (beta = 0.34, P = 0.04) independent of MBP. The MBP-by-epinephrine AUC interaction predicted FVII:C AUC (beta = 0.28) and fibrinogen AUC (beta = -0.30), and the MBP-by-norepinephrine AUC interaction predicted FVIII:C AUC (beta = -0.28), all with borderline significance (Ps < 0.09) and independent of age and BMI. MBP significantly altered the association between stress hormones and coagulation activity at rest and, with borderline significance, across the entire stress and recovery interval. Independent of MBP, catecholamines were associated with procoagulant effects and cortisol reactivity dampened the acute procoagulant stress response.

Technical note: adipose tissue blood flow in miniature swine (Sus scrofa) using the 133xenon washout technique.

PubMed

Moher, H E; Carey, G B

2002-05-01

The purpose of this study was to examine the 133xenon washout technique as a viable method for measuring adipose tissue blood flow (ATBF) in swine. Using a total of 32 female Yucatan miniature swine (Sus scrofa), the partition coefficient for 133xenon in swine subcutaneous adipose tissue was determined and ATBF was measured at rest and under various physiological conditions. These conditions included feeding, anesthesia, epinephrine infusion, and acute exercise. The effects of epinephrine and acute exercise were examined in both sedentary and exercise-trained swine. The partition coefficient value for 133xenon in swine subcutaneous adipose tissue was 9.23+/-0.26 mL/g (mean +/- SD, n = 10). The average value for resting ATBF in swine was 3.98+/-2.72 mL/(100 g tissue-min) (n = 19). Feeding increased ATBF by approximately fivefold over fasting values, and isoflurane anesthesia significantly decreased ATBF compared to rest (1.64+/-1.12 vs 3.92+/-4.22 mL/[100 g x min], n = 10). A 30-min epinephrine infusion (1 microg/[kg BW x min]) significantly increased ATBF from a resting value of 3.13+/-2.61 to 10.35+/-5.31 mL/(100 g x min) (n = 12). Epinephrine infusion into exercise-trained swine increased ATBF to the same extent as when infused into sedentary swine. An acute, 20-min bout of exercise significantly increased ATBF in swine, and the sedentary swine showed a larger increase in ATBF than their exercise-trained littermates relative to rest: 7.83 vs 2.98 mL/(100 g x min). In conclusion, the 133xenon washout technique appears to be a viable method for measuring ATBF in swine; our findings are comparable to swine ATBF values reported using the microsphere method and are consistent with values reported in animal and human studies.

Anesthetic efficacy and heart rate effects of the intraosseous injection of 1.5% etidocaine (1:200,000 epinephrine) after an inferior alveolar nerve block.

PubMed

Stabile, P; Reader, A; Gallatin, E; Beck, M; Weaver, J

2000-04-01

The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous (IO) injection of 1.5% etidocaine with 1:200,000 epinephrine after an inferior alveolar nerve block. In a repeated-measures designed study, 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were an inferior alveolar nerve (IAN) block (with 3% mepivacaine) + IO injection with 1.8 mL of 1.5% etidocaine hydrochloride containing 1:200,000 epinephrine, and an IAN + mock IO injection. The first molar was blindly tested with a pulp tester at 2-minute cycles for 60 minutes after the injection. Anesthesia was considered successful when 2 consecutive 80 readings (no subject response) were obtained. Heart rate (pulse rate) was measured with a pulse oximeter. Lip numbness occurred in 100% of the subjects with both the techniques. For the first molar, anesthetic success for the IAN + mock IO and the IAN + IO etidocaine hydrochloride groups, respectively, were 81% and 100%. The differences were significant (P <.05) when the IAN + IO etidocaine hydrochloride technique was compared with the IAN + mock IO. A mean increase in heart rate of 32 beats/min occurred in 90% of the subjects with the IO injection of the etidocaine hydrochloride solution. In 89% of these subjects, the heart rate returned to within 5 beats of baseline values 4 minutes or less after solution deposition. The IO injection of 1.8 mL of 1.5% etidocaine hydrochloride with 1:200,000 epinephrine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success in the first molar. The majority of subjects receiving the IO injection of the etidocaine hydrochloride solution had a transient increase in heart rate.

Comparison of speed of action and injection discomfort of 4% articaine and 2% mepivacaine for pulpal anesthesia in mandibular teeth: A randomized, double-blind cross-over trial

PubMed Central

Gazal, Giath

2015-01-01

Objective: To compare the injection pain and speed of local anesthetic effect induced by tissue infiltration of mepivacaine 2% with epinephrine 1:100,000 versus articaine 4% with epinephrine 1:100,000 in securing mandibular first molar pulp anesthesia. Materials and Methods: Totally, 25 patients were recruited in a crossover, randomized, double-blind study. Each subject received injections of mepivacaine 2% with epinephrine 1:100,000 as inferior alveolar nerve block (IANB) supplemented with either articaine 4% with epinephrine 1:100,000 (septocaine) or mepivacaine 2% buccal infiltration (BI) injection on two visits. The time of first numbness to associated lip, tongue and tooth was recorded by asking the participant directly and using electrical pulp tester. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation. The patients rated the pain of infiltration using a 100 mm visual analog scale immediately after receiving each injection. The pain scores were compared using the paired t-test. Results: There were significant differences in the meantime of first numbness to associated lip and tooth of volunteers between mepivacaine and articaine BI groups P = 0.03 and 0.002. Volunteers in articaine group recorded earlier lip and teeth numbness than those in mepivacaine group. There were significant differences between the mean pain scores for volunteers in the post IANB and postbuccal injection groups (t-test: P <0.001). Mepivacaine IANB injection was significantly more painful than articaine/mepivacaine buccal injection. Conclusions: About 4% articaine was faster than 2% mepivacaine (both with 1:100,000 adrenaline) in anesthetizing the pulps of lower molar teeth after BIs. Earlier lip and teeth numbness were recorded in articaine group. Articaine and mepivacaine BIs were more comfortable than mepivacaine IANB injections. PMID:26038650

Analysis of Stress Indicators for Evaluation of Animal Welfare and Meat Quality in Traditional and Jewish Slaughtering

PubMed Central

Barrasso, Roberta; Marchetti, Patrizia; Samoilis, Giorgio; Tantillo, Giuseppina; Ceci, Edmondo

2018-01-01

Simple Summary Cortisol and catecholamines (dopamine, norepinephrine and epinephrine) are released in response to stress and directly stimulate glycogen mobilization, thus influencing meat acidification. The aim of the study was to estimate and compare these stress indicators to evaluate the welfare of beef cattle, subjected to either traditional slaughtering (with stunning) or to slaughtering with religious Jewish rite (without stunning). Significant differences in plasma cortisol and catecholamine levels were observed during exsanguination by monitoring animals in the pre-slaughtering (before and after transportation) and slaughtering phases. Cortisol, dopamine and norepinephrine, but not epinephrine, were markedly higher in the animals slaughtered by the religious rite. Pursuing animal welfare in the religious slaughtering procedures could produce advantages in terms of hygiene, organoleptic quality and shelf life of meat. Abstract Sixty Charolais male beef cattle of eight months of age were divided into two groups according to the slaughtering method, i.e., traditional or Kosher (religious Jewish rite). The aim of the study was to detect and compare the plasma concentrations of cortisol and catecholamines (dopamine, norepinephrine and epinephrine), by Elisa and HPLC test. These four stress indicators were evaluated during three different stages of each animal productive life: on the farm (step 1), after transportation (step 2) and during bleeding (step 3). The patterns of the parameters measured were similar and, interestingly, revealed significant changes throughout the three steps considered. The greatest variation between the two methods of slaughtering was observed in step 3, where we found a statistically significant difference with all the parameters except epinephrine. In the animals slaughtered by the religious rite, cortisol, dopamine, norepinephrine and epinephrine were 68.70 ± 30.61 nmol/L; 868.43 ± 508.52 ng/L; 3776.20 ± 1918.44 ng/L; and 4352.20 ± 3730.15 ng/L, respectively, versus 45.08 ± 14.15 nmol/L; 513.87 ± 286.32 ng/L; 3425.57 ± 1777.39 ng/L; and 3279.97 ± 1954.53 ng/L, respectively, in the other animals. This suggests that the animals slaughtered by the Kosher rite are subjected to higher stress conditions at the exsanguination phase. The animals slaughtered by the religious Jewish rite showed lower cortisol and catecholamine levels on the farm (step 1) and after transportation to the slaughterhouse (step 2). This was likely because the animals selected at the end of step 1 by the Rabbis for the religious rite are usually the most docile and gentle. PMID:29561752

Effect of pre-slaughter physiological conditions on the oxidative stability of colour and lipid during chill storage of sliced, retail packed roast ham.

PubMed

Juncher, Dorte; Rønn, Birgitte; Beck Hansen, Tina; Henckel, Poul; Karlsson, Anders; Skibsted, Leif H; Bertelsen, Grete

2003-02-01

Pre-slaughter physiological conditions (A serving as control, B subjected to treadmill exercise immediately prior to stunning, C epinephrine injection 15 h prior to slaughter, and D epinephrine injection 15 h prior to slaughter and subjected to treadmill exercise immediately before stunning) were found to significantly affect colour and lipid oxidation of sliced, retail packed roast ham, produced from nitrite-cured (78 ppm nitrite) M. Longissimus dorsi. The pre-slaughter treatment resulted in variations in the level of glycogen, lactate, ATP and IMP and pH development as monitored in Longissimus dorsi muscles, with the lowest ultimate pH (pH(u)) in muscles from non-epinephrine treated pigs (treatments A and B). The initial tristimulus L(∗)-value and the L(∗)-value during chill storage of sliced roast ham packed in laminates with low or with very low oxygen transmission rate (OTR=40 and <0.5 cm(3)/m(2)/atm/24 h, respectively) were significantly affected by treatment, although the effect of the treatments was different during storage for 28 days (interaction between treatment and storage time). Roast ham from treatments A and B generally had a paler appearance (higher L(∗)-values) than from treatments C and D. No differences in the initial tristimulus a(∗)-values (redness) were found. During chill storage, a pronounced colour fading (decrease in a(∗)-values) was seen for laminate with low OTR, with a tendency of better colour stability for treatment C than A, but with no differences for the other treatments. For laminates with very low OTR, the cured meat pigment was stable with no decreases in a(∗)-values during storage. Lipid oxidation (thiobarbituric acid reactive substances, TBARS) in products in laminates with low OTR increased during storage and was significantly higher for roast ham from non-epinephrine treated pigs (A and B) than for ham from epinephrine-treated pigs (C and D). Statistical analysis relating pH and the level of glycogen, lactate, creatine phosphate, ATP and IMP in the individual pigs to the product quality parameters revealed that the ultimate level of lactate was the most important single parameter affecting product quality. After 28 days of chill storage, roast ham from pigs subjected to treatments C and D were more likely to support bacterial growth than from treatments A and B. In conclusion, the results show that pre-slaughter physiological conditions are of importance for chemical as well as for microbiological changes in retail stored roast ham.

Love, marriage, and divorce: newlyweds' stress hormones foreshadow relationship changes.

PubMed

Kiecolt-Glaser, Janice K; Bane, Cynthia; Glaser, Ronald; Malarkey, William B

2003-02-01

Neuroendocrine function, assessed in 90 couples during their first year of marriage (Time 1), was related to marital dissolution and satisfaction 10 years later. Compared to those who remained married, epinephrine levels of divorced couples were 34% higher during a Time 1 conflict discussion, 22% higher throughout the day, and both epinephrine and norepinephrine were 16% higher at night. Among couples who were still married, Time 1 conflict ACTH levels were twice as high among women whose marriages were troubled 10 years later than among women whose marriages were untroubled. Couples whose marriages were troubled at follow-up produced 34% more norepinephrine during conflict, 24% more norepinephrine during the daytime, and 17% more during nighttime hours at Time 1 than the untroubled.

[Catecholamines and their metabolites in children with Asperger and Kanner syndromes].

PubMed

Gorina, A S; Kolesnichenko, L S; Mikhnovich, V I

2011-01-01

Children with Asperger and Kanner syndromes in the stable state demonstrate similar decrease in plasma norepinephrine. In the aggravated state, these changes become more expressed and are characterized by a decrease in plasma tyrosine, norepinephrine, normetanephrine and by an increase in dopamine and homovanylic acid and a decrease in excretion of norepinephrine and an increase in excretion of homovanylic acid, epinephrine and MHPG. Only in children with Kanner syndrome in the aggravated state plasma MHPG increases, excretion of tyrosine decreases and excretion of normetanephrine increases. The observed imbalance in dopamine and epinephrine/norepinephrine systems justifies combined analysis of changes in catecholamines and their metabolites levels as the most informative approach in the study of the effect of autistic disorders.

Psychophysiological reactions to telework in female and male white-collar workers.

PubMed

Lundberg, Ulf; Lindfors, Petra

2002-10-01

Information technology has created greater flexibility and mobility for employees, such as teleworkers. However, research on stress and health is limited. This study investigated psychophysiological arousal in 26 highly educated white-collar workers (12 women and 14 men) while (a) working at the office, (b) working at home (telework), and (c) relaxing at home. Blood pressure was significantly higher during work at the office than when teleworking at home, and men had significantly elevated epinephrine levels in the evening after telework at home. It was assumed that the lower cardiovascular arousal during telework is due to different work tasks and that elevated epinephrine levels in men after telework are caused by continued work after normal working hours.

Regulation of extrarenal potassium homeostasis by adrenal hormones in rats.

PubMed

Bia, M J; Tyler, K A; DeFronzo, R A

1982-06-01

The effect of chronic (7-10 days) adrenal insufficiency on extrarenal potassium tolerance was examined by infusing potassium into rats after acute nephrectomy. The increment in plasma potassium concentration was significantly higher in glucocorticoid-replaced adrenalectomized rats versus controls (max delta PK 3.59 +/-0.11 vs. 2.93 +/- 0.08 meq/liter; P less than 0.001). The impairment in extrarenal potassium tolerance in adrenalectomized rats could not be attributed to acidemia, hypotension, changes in plasma insulin or glucose concentration, or potassium retention prior to study. Acute replacement with aldosterone resulted in significant improvement in the rise in plasma potassium after KCl (max delta PK 3.18 +/- 0.06 meq/liter; P less than 0.005 compared with aldosterone-deficient adrenalectomized rats but higher than in controls, P less than 0.02). If given on a chronic basis, aldosterone replacement led to a complete correction of the defect (max delta PK = 2.89 +/- 0.08 meq/liter). Acute epinephrine replacement in adrenalectomized rats also returned potassium tolerance to normal (max delta PK = 3.02 +/- 0.10 meq/liter). The results demonstrate that extrarenal potassium tolerance is impaired in chronic adrenal insufficiency and suggest that both aldosterone and epinephrine deficiency may contribute to the defect, since replacement with either hormone returns potassium tolerance toward normal. Accordingly, both aldosterone and epinephrine have important extrarenal mechanisms of action.

Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study.

PubMed

Idris, Mohamed; Sakkir, Nasil; Naik, Kishore Gopalakrishna; Jayaram, Nandakishore Kunijal

2014-09-01

The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia. Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation. Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection. Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

Dietary fat saturation and endurance exercise alter lipolytic sensitivity of adipocytes isolated from Yucatan miniature swine.

PubMed

Meservey, C M; Carey, G B

1994-12-01

This study examined the effects of dietary fat saturation and endurance exercise on lipolytic sensitivity of adipocytes isolated from Yucatan miniature swine. Twenty-four female swine had free access to a high fat diet with a polyunsaturated to saturated fat ratio (P:S) of 0.3 or 1.0, and were treadmill-exercised or remained sedentary. After 3 months, biopsies were taken, adipocytes were isolated and lipolytic activity was determined. Adipocytes were incubated with adenosine deaminase followed by epinephrine, isoproterenol, or epinephrine plus phenylisopropyladenosine, and glycerol release was measured. Backfat thickness was measured by ultrasonography. Our findings revealed that 1) adipocytes from 1.0 P:S diet-fed swine released 30% more glycerol than adipocytes from 0.3 P:S diet-fed swine when stimulated by 1 micromol/L isoproterenol; 2) adipocytes from exercised swine released 45% more glycerol than adipocytes from sedentary swine when stimulated by 1 micromol/L epinephrine; 3) body weight of exercised swine was significantly lower than sedentary swine; and 4) backfat thickness was less in exercised swine than in sedentary swine (2.39 vs. 2.95 cm, P = 0.002). We conclude that ad libitum consumption of diet with a P:S of 1.0, combined with endurance exercise, increases lipolytic sensitivity, lowers body weight gain, and reduces fat accumulation in female Yucatan miniature swine.

Efficacy and safety of 1% ropivacaine for postoperative analgesia after lower third molar surgery: a prospective, randomized, double-blinded clinical study.

PubMed

Brković, Božidar; Andrić, Miroslav; Ćalasan, Dejan; Milić, Marija; Stepić, Jelena; Vučetić, Milan; Brajković, Denis; Todorović, Ljubomir

2017-04-01

The purpose of this study was to investigate postoperative analgesic effect of ropivacaine administered as main or supplemental injection for the inferior alveolar nerve block (IANB) in patients undergoing lower third molar surgery. The double-blind randomized study comprised 72 healthy patients. All patients received two blocks, the IANB for surgical procedure + IANB after surgery for postoperative pain control, and were divided into three groups: (1) 2 % lidocaine/epinephrine + 1 % ropivacaine, (2) 2 % lidocaine/epinephrine + saline, and (3) 1 % ropivacaine + saline. The occurrence of postoperative pain, pain intensity and analgesic requirements were recorded. Data were statistically analyzed using chi-square, Fisher, and Kruskal-Wallis tests and analysis of variance (ANOVA) with Bonferroni and Tukey correction. Ropivacaine was more successful than lidocaine/epinephrine in obtaining duration of postoperative analgesia, reduction of pain, and analgesic requirements whether ropivacaine was used for surgical block or administered as a supplemental injection after surgery. Ropivacaine (1 %, 2 ml) resulted in effective postoperative analgesia after lower third molar surgery. Since pain control related to third molar surgery requires the effective surgical anesthesia and postoperative analgesia, the use of 1 % ropivacaine could be clinically relevant in a selection of appropriate pain control regimen for both surgical procedure and early postsurgical treatment.

Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study

PubMed Central

Idris, Mohamed; Sakkir, Nasil; Naik, Kishore Gopalakrishna; Jayaram, Nandakishore Kunijal

2014-01-01

Background: The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. Aim: A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia. Materials and Methods: Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation. Results: Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection. Conclusion: Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:25298642

Anaphylaxis

MedlinePlus

... foods. When eating out, tell the server or chef about your allergy. If you are allergic to ... medicine is called an epinephrine injector (EpiPen). Family, friends, and coworkers should know how to use it. ...

Effect of fluorocarbons on acetylcholinesterase activity and some counter measures

NASA Technical Reports Server (NTRS)

Young, W.; Parker, J. A.

1975-01-01

An isolated vagal sympathetic heart system has been successfully used for the study of the effect of fluorocarbons (FCs) on cardiac performance and in situ enzyme activity. Dichlorodifluoromethane sensitizes this preparation to sympathetic stimulation and to exogenous epinephrine challenge. Partial and complete A-V block and even cardiac arrest have been induced by epinephrine challenge in the FC sensitized heart. Potassium chloride alone restores the rhythmicity but not the normal contractility of the heart in such a situation. Addition of glucose will, however, completely restore the normal function of the heart which is sensitized by dichlorodifluoromethane. The ED 50 values of acetylcholinesterase activity which are used as a measure of relative effectiveness of fluorocarbons are compared with the maximum permissible concentration. Kinetic studies indicate that all the fluorocarbons tested so far are noncompetitive.

Periodic neutropenia and monocytopenia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adams, W.H.; Liu, Y.K.

A patient with periodic neutropenia exhibited simultaneous monocytopenia, and epinephrine infusion revealed no monocytes in the marginating pool during neutropenia. Lymphocytes, eosinophils, and platelets also fluctuated periodically, but serial bone marrow studies and epinephrine infusion data indicate these fluctuations could have represented epiphenomena rather than a more global form of periodic hematopoiesis. Bone marrow descriptions of most cases of periodic neutropenia have indicated a ''maturation arrest'' at the promyelocyte or myelocyte stage prior to development of neutropenia; peripheral blood monocytes are usually normal or fluctuate out of phase with neutrophils. In the present case, ''maturation arrest'' occurred at the myeloblastmore » stage, and neutrophils and monocytes cycled together. Morphologically normal eosinophilopoiesis with a mean eosinophil to erythroid ratio in the marrow of 0.27 +/- 0.10 (SD) persisted despite a sustained disappearance of promyelocytes.« less

Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block.

PubMed

Singla, M; Subbiya, A; Aggarwal, V; Vivekanandhan, P; Yadav, S; Yadav, H; Venkatesh, A; Geethapriya, N; Sharma, V

2015-01-01

To compare the anaesthetic efficacy of different volumes (1.8 mL vs. 3.6 mL) of 4% articaine with 1 : 100 000 epinephrine injected as buccal infiltrations after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Two hundred and thirty-four adult patients, diagnosed with irreversible pulpitis in a mandibular tooth, participated in this multicentre, randomized double-blinded trial. Patients received IANB with 1.8 mL of 4% articaine with 1 : 100 000 epinephrine. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp chamber access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Patients who experienced 'moderate-to-severe' pain (HP VAS score ≥ 55 mm) were randomly allocated into two groups and received buccal infiltrations with either 1.8 mL or 3.6 mL of 4% articaine with 1 : 100 000 epinephrine. Root canal treatment was re-initiated after 10 min. Success was again defined as no pain or weak/mild pain during endodontic access preparation and instrumentation. Statistical analysis was performed using Mann-Whitney U and chi-square tests. The initial IANB of 4% articaine gave an overall success rate of 37%. The success rate of supplementary buccal infiltration with 1.8 and 3.6 mL volumes was 62% and 64%, respectively. The difference between the success rates of the two volumes was not statistically significant. Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Relationship between Vagal Tone, Cortisol, TNF-Alpha, Epinephrine and Negative Affects in Crohn’s Disease and Irritable Bowel Syndrome

PubMed Central

Pellissier, Sonia; Dantzer, Cécile; Mondillon, Laurie; Trocme, Candice; Gauchez, Anne-Sophie; Ducros, Véronique; Mathieu, Nicolas; Toussaint, Bertrand; Fournier, Alicia; Canini, Frédéric; Bonaz, Bruno

2014-01-01

Crohn’s disease (CD) and irritable bowel syndrome (IBS) involve brain-gut dysfunctions where vagus nerve is an important component. The aim of this work was to study the association between vagal tone and markers of stress and inflammation in patients with CD or IBS compared to healthy subjects (controls). The study was performed in 73 subjects (26 controls, 21 CD in remission and 26 IBS patients). The day prior to the experiment, salivary cortisol was measured at 8∶00 AM and 10∶00 PM. The day of the experiment, subjects completed questionnaires for anxiety (STAI) and depressive symptoms (CES-D). After 30 min of rest, ECG was recorded for heart rate variability (HRV) analysis. Plasma cortisol, epinephrine, norepinephrine, TNF-alpha and IL-6 were measured in blood samples taken at the end of ECG recording. Compared with controls, CD and IBS patients had higher scores of state-anxiety and depressive symptomatology. A subgroup classification based on HRV-normalized high frequency band (HFnu) as a marker of vagal tone, showed that control subjects with high vagal tone had significantly lower evening salivary cortisol levels than subjects with low vagal tone. Such an effect was not observed in CD and IBS patients. Moreover, an inverse association (r = −0.48; p<0.05) was observed between the vagal tone and TNF-alpha level in CD patients exclusively. In contrast, in IBS patients, vagal tone was inversely correlated with plasma epinephrine (r = −0.39; p<0.05). No relationship was observed between vagal tone and IL-6, norepinephrine or negative affects (anxiety and depressive symptomatology) in any group. In conclusion, these data argue for an imbalance between the hypothalamus-pituitary-adrenal axis and the vagal tone in CD and IBS patients. Furthermore, they highlight the specific homeostatic link between vagal tone and TNF-alpha in CD and epinephrine in IBS and argue for the relevance of vagus nerve reinforcement interventions in those diseases. PMID:25207649

Anesthetic efficacy of the intraosseous injection of 0.9 mL of 2% lidocaine (1:100,000 epinephrine) to augment an inferior alveolar nerve block.

PubMed

Reitz, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-11-01

The purpose of this study was to determine the anesthetic efficacy of an intraosseous injection of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine to augment an inferior alveolar nerve block in mandibular posterior teeth. With the use of a repeated-measures design, each of 38 subjects randomly received one or the other of 2 combinations of injections at 2 separate appointments. The combinations were inferior alveolar nerve block + intraosseous injection (on the distal of the second premolar) through use of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine and inferior alveolar nerve block + mock intraosseous injection. The first molar, second premolar, and second molar were blindly tested with an Analytic Technology pulp tester at 2-minute cycles for 120 minutes postinjection. Anesthesia was considered successful when 2 consecutive 80 readings were obtained. One hundred percent of the subjects had lip numbness with the inferior alveolar nerve block + intraosseous injection combination technique. The respective anesthetic success rates for the inferior alveolar nerve block + mock intraosseous injection combination and the inferior alveolar nerve block + intraosseous injection combination were 60% and 100% for the second premolar, 71% and 95% for the first molar, and 74% and 87% for the second molar. The differences were significant (P < .05) for the second premolar through 50 minutes and for the first molar through 20 minutes. There were no significant (P > .05) differences for the second molar. Sixty-eight percent of the subjects had a subjective increase in heart rate with the intraosseous injection. The results of this study indicate that the supplemental intraosseous injection of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine, given distal to the second premolar, significantly increased the success of pulpal anesthesia in the second premolar (for 50 minutes) and first molar (for 20 minutes) in comparison with the inferior alveolar nerve block alone. The intraosseous injection did not statistically increase success in the second molar.

Differential regulation of the cell cycle by alpha1-adrenergic receptor subtypes.

PubMed

Gonzalez-Cabrera, Pedro J; Shi, Ting; Yun, June; McCune, Dan F; Rorabaugh, Boyd R; Perez, Dianne M

2004-11-01

Alpha(1)-Adrenergic receptors have been implicated in growth-promoting pathways. A microarray study of individual alpha(1)-adrenergic receptor subtypes (alpha(1A), alpha(1B), and alpha(1D)) expressed in Rat-1 fibroblasts revealed that epinephrine altered the transcription of several cell cycle regulatory genes in a direction consistent with the alpha(1A)- and alpha(1D)-adrenergic receptors mediating G(1)-S cell cycle arrest and the alpha(1B-)mediating cell-cycle progression. A time course indicated that in alpha(1A) cells, epinephrine stimulated a G(1)-S arrest, which began after 8 h of stimulation and maximized at 16 h, at which point was completely blocked with cycloheximide. The alpha(1B)-adrenergic receptor profile also showed unchecked cell cycle progression, even under low serum conditions and induced foci formation. The G(1)-S arrest induced by alpha(1A)- and alpha(1D)-adrenergic receptors was associated with decreased cyclin-dependent kinase-6 and cyclin E-associated kinase activities and increased expression of the cyclin-dependent kinase inhibitor p27(Kip1), all of which were blocked by prazosin. There were no differences in kinase activities and/or expression of p27(Kip1) in epinephrine alpha(1B)-AR fibroblasts, although the microarray did indicate differences in p27(Kip1) RNA levels. Cell counts proved the antimitotic effect of epinephrine in alpha(1A) and alpha(1D) cells and indicated that alpha(1B)-adrenergic receptor subtype expression was sufficient to cause proliferation of Rat-1 fibroblasts independent of agonist stimulation. Analysis in transfected PC12 cells also confirmed the alpha(1A)- and alpha(1B)-adrenergic receptor effect. The alpha(1B)-subtype native to DDT1-MF2 cells, a smooth muscle cell line, caused progression of the cell cycle. These results indicate that the alpha(1A)- and alpha(1D)-adrenergic receptors mediate G(1)-S cell-cycle arrest, whereas alpha(1B)-adrenergic receptor expression causes a cell cycle progression and may induce transformation in sensitive cell lines.

School Access to Emergency Epinephrine Act

THOMAS, 112th Congress

Sen. Durbin, Richard J. [D-IL

2011-11-17

Senate - 11/17/2011 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Asthma and Allergy Foundation of America

MedlinePlus

... Albuterol in Schools Access to Medications Clean Air Climate and Health Epinephrine in Schools Healthy Settings Food ... Allergy Capitals Anaphylaxis in America Extreme Allergies and Climate Change Access to Pseudoephedrine Consensus Study on Food ...

[The effects of epinephrine and adrenergic antagonists on adenosine 3', 5'-monophosphate level of bovine trabecular cells in vitro].

PubMed

Lu, Y; Li, M; Shen, Y

1998-03-01

To determine the effects of epinephrine (EPI) and adrenergic antagonists on adenosine 3', 5'-monophosphate (cAMP) level of bovine trabecular cells (BTC) in vitro. (3)H-cAMP was used in protein binding assay for measuring the intracellular level of cAMP. (1) 10(-5) mol/L EPI induced a fold increase of cAMP in cultured BTC in vitro; (2) Timilol and ICI 118, 551 blocked efficiently the effect of EPI at a lower concentration (10(-6) mol/L). (3) Bisoprolol did not efficiently block the effect of EPI unless at high concentrations (>or= 10(-5) mol/L). The effects of EPI increasing outflow facility may be associated with its increase of cAMP in trabecular cells; BTC contains beta-adrenergic receptors, and beta(2)-adrenergic receptors are dominant.

Proposed use of adrenaline (epinephrine) in anaphylaxis and related conditions: a study of senior house officers starting accident and emergency posts

PubMed Central

Gompels, L; Bethune, C; Johnston, S; Gompels, M

2002-01-01

Senior house officers (SHOs) (n=78) at the start of their accident and emergency (A&E) post were given an anonymous five case history questionnaire, containing one case of true anaphylaxis, and asked to complete the medication they would prescribe. In the case of anaphylaxis, 100% would administer adrenaline (epinephrine) but 55% would do so by the incorrect route. In the remaining cases, 10%–56% would be prepared to administer adrenaline inappropriately. Only 5% were able to indicate the correct route and dose of adrenaline according to Resuscitation Council guidelines (UK). This has implications for training as the survey took place before the start of the A&E posting. Anaphylaxis is over-diagnosed and poorly treated despite Resuscitation Council guidelines. PMID:12151658

Simultaneous determination of epinephrene and paracetamol at copper-cobalt oxide spinel decorated nanocrystalline zeolite modified electrodes.

PubMed

Samanta, Subhajyoti; Srivastava, Rajendra

2016-08-01

In this study, CuCo2O4 and CuCo2O4 decorated nanocrystalline ZSM-5 materials were prepared. For comparative study, a series of MCo2O4 spinels were also prepared. Materials were characterized by the complementary combination of X-ray diffraction, N2-adsorption, UV-visible, and electron microscopic techniques. A simple and rapid method for the simultaneous determination of paracetamol and epinephrine at MCo2O4 spinels modified electrodes is presented in this manuscript. Among the materials investigated in this study, CuCo2O4 decorated nanocrystalline ZSM-5 exhibited the highest electrocatalytic activity with excellent stability, sensitivity, and selectivity. Analytical performance of the sensor was demonstrated in the determination of epinephrine and paracetamol in the commercial pharmaceutical samples. Copyright © 2016 Elsevier Inc. All rights reserved.

A Combination of Dexmedetomidine and Lidocaine Is a Cardiovascularly Safe Dental Local Anesthetic for Hypertensive Rats Treated With a Nonselective β-Adrenergic Antagonist.

PubMed

Tsutsui, Yukako; Sunada, Katsuhisa

2017-01-01

Hypertensive patients receiving nonselective β-adrenergic antagonists are vulnerable to hypertension and bradycardia when injected with dental local anesthetic formulations containing epinephrine. Dexmedetomidine (DEX), an α 2 -adrenergic agonist, has been reported to prolong and enhance the local anesthetic effects of lidocaine. The cardiovascular effects of the DEX-lidocaine combination have not yet been investigated in the presence of nonselective β-adrenergic antagonists. Therefore, we assessed the cardiovascular effects of the DEX-lidocaine combination in spontaneously hypertensive rats (SHR) treated with a nonselective β-adrenergic antagonist (propranolol). We injected propranolol-treated rats with various concentrations of DEX alone, 100 μg/kg epinephrine alone, or 5 μg/kg DEX combined with 2% lidocaine and measured their blood pressure (BP) and heart rates (HR) to assess the cardiovascular effects. The BP of propranolol-treated SHR was significantly increased by treatment with 100 μg/kg epinephrine alone. The BP and HR of propranolol-treated SHR were not significantly changed by treatment with low concentrations of DEX, but they were significantly decreased by treatment with a high concentration of DEX (50 μg/kg). Moreover, there was no significant difference in the BP and HR of propranolol-treated SHR after the injection of a combination of 5 μg/kg DEX and 2% lidocaine. Thus, the DEX-lidocaine combination may be an acceptable addition to dental local anesthetic solutions from a cardiovascular standpoint for hypertensive patients receiving nonselective β-adrenergic antagonists.

Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children.

PubMed

Rappaport, Lara D; Brou, Lina; Givens, Tim; Mandt, Maria; Balakas, Ashley; Roswell, Kelley; Kotas, Jason; Adelgais, Kathleen M

2016-01-01

The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape™ (Broselow) and Handtevy LBT™ (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1-year-old and 5-year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8%) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.

Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery

PubMed Central

2017-01-01

Background There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. Method This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. Results The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. Conclusion We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery. PMID:28879339

Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery.

PubMed

Sawang, Kamonpun; Chaiyasamut, Teeranut; Kiattavornchareon, Sirichai; Pairuchvej, Verasak; Bhattarai, Bishwa Prakash; Wongsirichat, Natthamet

2017-06-01

There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.

Effect of beta-ADrenergic Agonist on Cyclic AMP Synthesis in Chicken Skeletal Muscle Cells in Culture

NASA Technical Reports Server (NTRS)

Young, R. B.; Bridge, K. Y.; Rose, M. Franklin (Technical Monitor)

2000-01-01

Several beta-adrenergic receptor (bAR) agonists are known to cause hypertrophy of skeletal muscle tissue. Because it seems logical that these agonists exert their action on muscle through stimulation of cAMP synthesis, five bAR agonists encompassing a range in activity from strong to weak were evaluated for their ability to stimulate cAMP accumulation in embryonic chicken skeletal muscle cells in culture. Two strong agonists (epinephrine and isoproterenol), one moderate agonist (albuterol), and two weak agonists known to cause hypertrophy in animals (clenbuterol and cimaterol) were studied. Dose response curves were determined over six orders of magnitude in concentration for each agonist, and values were determined for their maximum stimulation of cAMP synthesis rate (Bmax) and the agonist concentration at which 50% stimulation of cAMP synthesis (EC50) occurred. Bmax values decreased in the following order: isoproterenol, epinephrine, albuterol, cimaterol, clenbuterol. Cimaterol and clenbuterol at their Bmax levels were approximately 15-fold weaker than isoproterenol in stimulating the rate of cAMP synthesis. In addition, the EC50 values for isoproterenol, cimaterol, clenbuterol, epinephrine, and albuterol were 360 nM, 630 nM, 900 nM, 2,470 nM, and 3,650 nM, respectively. Finally, dose response curves show that the concentrations of cimaterol and clenbuterol in culture media at concentrations known to cause significant muscle hypertrophy in animals had no detectable effect on stimulation of CAMP accumulation in chicken skeletal muscle cells.

Emotionally arousing pictures increase blood glucose levels and enhance recall.

PubMed

Blake, T M; Varnhagen, C K; Parent, M B

2001-05-01

Arousal enhances memory in human participants and this enhancing effect is likely due to the release of peripheral epinephrine. As epinephrine does not readily enter the brain, one way that peripheral epinephrine may enhance memory is by increasing circulating blood glucose levels. The present study investigated the possibility that emotionally arousing color pictures would improve memory and elevate blood glucose levels in human participants. Blood glucose levels were measured before, 15 min, and 30 min after male university students viewed 60 emotionally arousing or relatively neutral pictures. Participants viewed each picture for 6 s and then had 10 s to rate the arousal (emotional intensity) and valence (pleasantness) of each picture. A free-recall memory test was given 30 min after the last picture was viewed. Although the emotionally arousing and neutral picture sets were given comparable valence ratings, participants who viewed the emotionally arousing pictures rated the pictures as being more arousing, recalled more pictures, and had higher blood glucose levels after viewing the pictures than did participants who viewed the neutral pictures. These findings indicate that emotionally arousing pictures increase blood glucose levels and enhance memory, and that this effect is not due to differences in the degree of pleasantness of the stimuli. These findings support the possibility that increases in circulating blood glucose levels in response to emotional arousal may be part of the biological mechanism that allows emotional arousal to enhance memory. Copyright 2001 Academic Press.

Time Trends in Food Allergy Diagnoses, Epinephrine Orders, and Epinephrine Administrations in New York City Schools.

PubMed

Feuille, Elizabeth; Lawrence, Cheryl; Volel, Caroline; Sicherer, Scott H; Wang, Julie

2017-11-01

To assess time trends in food allergy diagnoses, epinephrine autoinjector (EAI) prescriptions, and EAI administrations in the school setting. In this retrospective study, deidentified student data from the New York City Department of Health and Mental Hygiene, which oversees >1 million students in 1800 schools, were provided to investigators. Data from school years 2007-2008 to 2012-2013 pertaining to diagnoses of food allergy, student-specific EAI orders, and EAI administrations among students in New York City were analyzed for trends over time, via the use of ORs and χ 2 calculation. The prevalences of providing physician documentation of food allergy and EAI orders, and the incidence of EAI administrations, all increased approximately 3-fold over the years of the study. Of 337 EAI administrations, more than one-half used stock EAI, and three-quarters were for students without a student-specific order preceding the incident. The rise in food allergy diagnoses, EAI prescriptions, and EAI administrations suggest either a true increase in allergic disease, increased reporting, and/or, in the case of EAI administrations, increased appropriate use. As the majority of EAI administrations used stock supply, availability of nonstudent-specific stock EAI appears vital to management of anaphylaxis in schools. Collaboration between physicians, families, and schools is needed to identify students at risk for severe allergic reactions and to ensure preparedness and availability of EAI in the event of anaphylaxis. Copyright © 2017 Elsevier Inc. All rights reserved.

Update on pediatric resuscitation drugs: high dose, low dose, or no dose at all.

PubMed

Sorrentino, Annalise

2005-04-01

Pediatric resuscitation has been a topic of discussion for years. It is difficult to keep abreast of changing recommendations, especially for busy pediatricians who do not regularly use these skills. This review will focus on the most recent guidelines for resuscitation drugs. Three specific questions will be discussed: standard dose versus high-dose epinephrine, amiodarone use, and the future of vasopressin in pediatric resuscitation. The issue of using high-dose epinephrine for cardiopulmonary resuscitation refractory to standard dose epinephrine has been a topic of debate for many years. Recently, a prospective, double-blinded study was performed to help settle the debate. These results will be reviewed and compared with previous studies. Amiodarone is a medication that was added to the pediatric resuscitation algorithms with the most recent recommendations from the American Heart Association in 2000. Its use and safety will also be discussed. Another topic that is resurfacing in resuscitation is the use of vasopressin. Its mechanism and comparisons to other agents will be highlighted, although its use in the pediatric patient has not been thoroughly studied. Pediatric resuscitation is a constantly evolving subject that is on the mind of anyone taking care of sick children. Clinicians are continually searching for the most effective methods to resuscitate children in terms of short- and long-term outcomes. It is important to be familiar with not only the agents being used but also the optimal way to use them.

Egg Allergy

MedlinePlus

... your child has had to have an epinephrine shot because of an allergic reaction, go immediately to a medical facility or hospital emergency room so they can provide additional treatment if needed. Up to one third of anaphylactic reactions can have a second ...

Comparison of ropivacaine and lidocaine with epinephrine for infiltration anesthesia in dentistry. A randomized study.

PubMed

Krzemiński, Tadeusz Faustyn; Gilowski, Łukasz; Wiench, Rafał; Płocica, Iwona; Kondzielnik, Piotr; Sielańczyk, Andrzej

2011-10-01

To compare the efficacy of maxillary infiltration anesthesia with 0.5% plain ropivacaine or 2% lidocaine with epinephrine 1:100,000. 60 volunteers received 1.8 ml of the anesthetic for infiltration anesthesia of maxillary central and lateral incisors and canine teeth. The onset time and duration of pulp anesthesia were assessed with an electric pulp tester. The duration time of numbness of the upper lip was also monitored. Blood pressure and heart rate were measured before and after administration of the solution. The efficacy of anesthesia of the lateral and central incisors was 100% for both anesthetics. There were small insignificant differences in effectiveness of canine pulp anesthesia. The mean onset time was significantly shorter for ropivacaine--2.2 minutes vs. 5.1 for lidocaine. Ropivacaine also had a significantly longer duration of action--mean time 79.2 minutes. Ropivacaine caused statistically significant increases in blood pressure and heart rate.

Glycogen depletion according to muscle and fibre types in response to dyadic encounters in pigs (Sus scrofa domesticus)--relationships with plasma epinephrine and aggressive behaviour.

PubMed

Fernandez, X; Meunier-Salaün, M C; Ecolan, P

1994-12-01

Changes in glycogen content according to fibre type were assessed in a predominantly white (Longissimus) and a predominantly red (Semispinalis) pig muscle, in response to dyadic encounters involving aggressive interactions. Tested animals showed significantly lower glycogen levels than the control in the Semispinalis, but not in the Longissimus muscle. Histological treatment of muscle serial cuts followed by computerized image analysis showed that the observed decrease in muscle Semispinalis glycogen level occurred only in fast-twitch fibres. Total glycogen and glycogen contents in fast-twitch fibres of the Semispinalis muscle were closely and negatively related to aggressive behaviour, but not with plasma epinephrine levels during and at the end of the encounters. The present results provide indirect evidences suggesting a major influence of fighting-induced physical activity on muscle glycogen depletion in response to aggressive interactions in pigs.

Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review

PubMed Central

DIBRA, A.; KËLLIÇI, S.; ÇELIKU, E.; DRAÇINI, Xh.; MATURO, A.; ÇELIKU, E.

2015-01-01

We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of NaCl 0.9% solution. Upper occlusion’s signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks. PMID:25827667

Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review.

PubMed

Dibra, A; Këlliçi, S; Çeliku, E; Draçini, Xh; Maturo, A; Çeliku, E

2015-01-01

We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.

ACTION OF CHEMICALLY DIFFERENT PROSTAGLANDIN BLOCKERS ON THE ADRENAL HORMONES IN PIGEONS DURING STRESS.

PubMed

Sarkar, S; Ghosh, S; Sengupta, S; Dasadhikari, S; Ghosh, A

1999-01-01

The effect of prostaglandin (PG) inhibitors differing in their chemical nature, viz. Aspirin (acetylsalicylic acid), Mefenamic acid (fenamates), Diclofenac (phenylacetic acid derivative) and Piroxicam (oxicam derivative) on the adrenal hormones was studied in acutely stressed pigeons. None of these PG blockers exerted any significant effect on the catecholamine and corticosterone content of the control, i.e. unstressed pigeon adrenal gland excepting mefenamic acid which caused a release of epinephrine. Aspirin, diclofenac and piroxicam did not modulate the catecholamine or corticosterone secretion whereas mefenamic acid caused a released of both epinephrine and norepinephrine and increased the adrenal corticosterone content in the acutely stressed pigeons. These results were compared with those obtained from studies on the effects of other chemically different PG blockers, indomethacin (a methylated indole derivative) and ibuprofen (a propionic acid derivative). It is suggested that chemically and structurally different PG inhibitors show diverse action in the same species under similar stress conditions.

Making Memories Matter

PubMed Central

Gold, Paul E.; Korol, Donna L.

2012-01-01

This article reviews some of the neuroendocrine bases by which emotional events regulate brain mechanisms of learning and memory. In laboratory rodents, there is extensive evidence that epinephrine influences memory processing through an inverted-U relationship, at which moderate levels enhance and high levels impair memory. These effects are, in large part, mediated by increases in blood glucose levels subsequent to epinephrine release, which then provide support for the brain processes engaged by learning and memory. These brain processes include augmentation of neurotransmitter release and of energy metabolism, the latter apparently including a key role for astrocytic glycogen. In addition to up- and down-regulation of learning and memory in general, physiological concomitants of emotion and arousal can also switch the neural system that controls learning at a particular time, at once improving some attributes of learning and impairing others in a manner that results in a change in the strategy used to solve a problem. PMID:23264764

Endocrine correlates of susceptibility to motion sickness

NASA Technical Reports Server (NTRS)

Kohl, R. L.

1985-01-01

Motion sickness releases ACTH, epinerphrine, and norepinephrine. The endocrine responses to motion sickness, adaptive responses leading to the resolution of the syndrome, and the way in which antimotion-sickness drugs influence the endocrine responses were studied. Susceptible or insusceptible subjects were administered antimotion-sickness drugs prior to stressful stimulation. Insusceptible subjects displayed more pronounced elevations of ACTH, epinephrine, and norepinephrine after stressful motion. Predrug levels of ACTH were higher in insusceptible subjects (p less than 0.01). Acute blockade of hormone responses to stressful motion or alteration of levels of ACTH by drugs were not correlated with individual susceptibility. No correlation was apparent between epinephrine and ACTH release. These endocrine differences may represent neurochemical markers for susceptibility to motion, stress, or general adaptability, and it may be that the chronic modulation of their levels might be more effective in preventing motion sickness than the acute blockage or stimulation of specific receptors.

Buffered lidocaine and bupivacaine mixture - the ideal local anesthetic solution?

PubMed

Best, Corliss A; Best, Alyssa A; Best, Timothy J; Hamilton, Danielle A

2015-01-01

The use of injectable local anesthetic solutions to facilitate pain-free surgery is an integral component of many procedures performed by the plastic surgeon. In many instances, a solution that has both rapid onset and prolonged duration of analgesia is optimal. A combination of lidocaine and bupivacaine, plain or with epinephrine, is readily available in most Canadian health care settings where such procedures are performed, and fulfills these criteria. However, commercially available solutions of both medications are acidic and cause a burning sensation on injection. Buffering to neutral pH with sodium bicarbonate is a practical method to mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available. The authors report on the proportions of the three drugs to yield a neutral pH, and the results of an initial survey regarding the use of the combined solution with epinephrine in hand surgery.

Multiple metal exposures and their correlation with monoamine neurotransmitter metabolism in Chinese electroplating workers.

PubMed

Wu, Lin-Lin; Gong, Wei; Shen, Si-Peng; Wang, Zhong-He; Yao, Jia-Xi; Wang, Jun; Yu, Jing; Gao, Rong; Wu, Gang

2017-09-01

Excessive metal exposure has been recognized as one of the detrimental factors for brain damage. However, the potential adverse effects induced by heavy metals on monoamine neurotransmitter pathways remains poorly understood. Our study aimed to investigate the possible association between metal exposure and neurotransmitter metabolism. By a cross-sectional investigation, 224 electroplating workers and 213 non-electroplating exposure workers were recruited in the exposure and control groups. Metal exposure levels were analyzed using inductively-coupled plasma mass spectrometry and monoamine neurotransmitter pathway metabolites were measured by ultra-performance liquid chromatography tandem mass spectrometry in human urine samples. Multivariate linear regression model was used to assess the dose-response relationships of urinary metals and neurotransmitter pathway metabolites. Significant dose-dependent trends of urinary vanadium quartiles with all metabolites were observed, and the trends demonstrated significance after multiple testing correction. It also showed that urinary chromium levels were significantly associated with decreased serotonin level and cadmium was positively associated with norepinephrine and epinephrine. In addition, arsenic was positively associated with tryptophan, serotonin, dopamine and norepinephrine. Iron was positively associated with increased homovanillic acid (HVA) and epinephrine while nickel was negatively associated with increased epinephrine levels. Zinc was positively related to tryptophan, kynurenin (KYN), 5-hydroxyindole acetic acid (5-HIAA), dopamine, HVA and norepinephrine. There was no significant association between urinary copper with any other metabolites after adjusting of multiple metal models. Metal exposure may be associated with neurotransmitter metabolism disturbances. The present work is expected to provide some support in the prevention and management of metal-associated neurological diseases. Copyright © 2017. Published by Elsevier Ltd.

Effect of educational and electronic medical record interventions on food allergy management.

PubMed

Zelig, Ari; Harwayne-Gidansky, Ilana; Gault, Allison; Wang, Julie

2016-09-01

The growing prevalence of food allergies indicates a responsibility among primary care providers to ensure that their patients receive accurate diagnosis and management. To improve physician knowledge and management of food allergies by implementing educational and electronic medical record interventions. Pre- and posttest scores of pediatric residents and faculty were analyzed to assess the effectiveness of an educational session designed to improve knowledge of food allergy management. One year later, a best practice advisory was implemented in the electronic medical record to alert providers to consider allergy referral whenever a diagnosis code for food allergy or epinephrine autoinjector prescription was entered. A review of charts 6 months before and 6 months after each intervention was completed to determine the impact of both interventions. Outcome measurements included referrals to an allergy clinic, prescription of self-injectable epinephrine, and documentation that written emergency action plans were provided. There was a significant increase in test scores immediately after the educational intervention (mean, 56.2 versus 84.3%; p < 0.001). Posttest scores remained significantly higher than preintervention scores 6 months later (mean score, 68.0 versus 56.2%; p = 0.006). Although knowledge improved, there was no significant difference in the percentage of patients who were provided allergy referral, were prescribed an epinephrine autoinjector, or were given an emergency action plan before and after both interventions. Neither intervention resulted in improvements in the management of children with food allergies at our pediatrics clinic. Further studies are needed to identify effective strategies to improve management of food allergies by primary care physicians.

Cardiotoxic (Arrhythmogenic) Effects of 1,1-Difluoroethane Due to Electrolyte Imbalance and Cardiomyocyte Damage.

PubMed

Joshi, Kaushal; Barletta, Michael; Wurpel, John

2017-06-01

Inhalant abuse is the intentional inhalation of chemical vapors to attain euphoric effects. Many common household products are abused by inhalation and one is 1,1-difluoroethane (DFE), which is a halogenated hydrocarbon used in refrigeration, dust-off spray, and airbrush painting. Although many human DFE abuse cases have been studied, the etiology and mechanism of sudden death is still unknown. In this study, an animal model was used to simulate the human conditions of DFE inhalation abuse that results in sudden death.Current research targets mechanistic studies involving electrolyte changes and cardiomyocyte damage after DFE administration in vivo. To investigate these changes, Sprague Dawley rats (N = 6) were exposed to 30 seconds of 20 L/min of DFE in multiple doses. Isoflurane acted as a control. Two additional groups, epinephrine and epinephrine + DFE, were included to simulate the clinical condition of DFE abuse. Plasma sodium, potassium, calcium, and magnesium levels were measured, followed by lactate dehydrogenase, creatine kinase, and cardiac troponin I levels. In addition, oxidative stress markers were also evaluated in all animal groups. Electrolyte levels showed a significant rise in plasma potassium and magnesium levels for the treated groups. In addition, lactate dehydrogenase, creatine kinase, and cardiac troponin I levels in DFE and epinephrine + DFE administered rats were significantly elevated as compared with control. Some oxidative stress makers were also elevated significantly in treatment groups. Furthermore, histopathological analysis showed hyperemia/congestion in treated rats.These results support cardiotoxic effects indicating that DFE results in fatal arrhythmias, and the study can be important during clinical cases involving inhalant abuse.

Dexmedetomidine (12.5 μg/mL) improves tissue distribution, anesthetic action, and hemodynamic effects of lidocaine after palatal infiltration in rats.

PubMed

Akimoto, Takuma; Hashimoto, Shuichi; Sunada, Katsuhisa

2016-09-01

Dexmedetomidine hydrochloride (DEX) is a α2-adrenergic receptor agonist that causes vasoconstriction by acting on α2B-adrenergic receptors in peripheral blood vessels. The authors aimed to determine the influence of DEX on tissue distribution, anesthetic action, and hemodynamic effects of lidocaine in rats. The investigators injected indigo carmine-containing (14)C-labeled lidocaine hydrochloride (2 %) without and with 3.1, 12.5, or 50 μg/mL DEX or 10 μg/mL epinephrine into the right palatal mucosa mesial to the maxillary first molar of specific pathogen-free male Wistar rats. Autoradiography and liquid scintillation counting were performed to evaluate (14)C-labeled lidocaine concentrations in the palatal mucosa, maxillary bone, maxillary nerve, and peripheral blood. Somatosensory-evoked potentials were measured to analyze anesthetic action, and blood pressure and pulse rate were measured to compare hemodynamic effects. DEX extended the tissue distribution of lidocaine in a concentration-dependent manner. Lidocaine with 12.5 μg/mL DEX had similar blood peak arrival time and peak-to-peak amplitude as lidocaine with 10 μg/mL epinephrine, but it reduced pulse rate. The results of this study suggest that 12.5 μg/mL DEX improves tissue distribution, anesthetic action, and hemodynamic effects of lidocaine in rats. Therefore, 12.5 μg/mL DEX may be a suitable alternative to epinephrine in lidocaine formulations, especially for patients with ischemic heart disease and hypertension.

Group dynamics and catecholamines during long-duration confinement in an isolated environment

NASA Technical Reports Server (NTRS)

Kraft, Norbert O.; Lyons, Terence J.; Binder, Heidi

2003-01-01

INTRODUCTION: The objectives of this study were to investigate possible relationships between catecholamine excretion and long-duration confinement in an isolated environment. METHODS: Stays of long duration were made by Group I (n = 4, all Russian, weeks 1-34), Group II (n = 4, mixed nationality, weeks 3-18), and Group III (n = 4, mixed nationality, weeks 22-38); other groups joined the residents for 1-wk intervals at weeks #13, #19, and #33. Data were collected from Groups I and III. RESULTS: In both Group I and Group III, the daily epinephrine excretion was significantly elevated during and after confinement compared with the pre-isolation baseline (p < 0.05), but remained mostly within normal limits during the experiment. During isolation, epinephrine excretion was significantly higher, compared with other weeks in isolation, during weeks #19 and #27 for Group I, and during week #30 for Group III. In both Group I and Group II, norepinephrine excretion increased significantly during and after isolation (p < 0.05) and was above the normal range. The daily norepinephrine excretion was significantly higher (p < 0.05) in Group I during weeks #12, #13, and #27, and during week #30 for Group III. DISCUSSION: Epinephrine excretion generally remained in the normal range. However, occasional elevations occurred due to psychological stress, which apparently correlate with changes in group dynamics. Norepinephrine excretion was above the normal range and was correlated with social events. These results suggest that to ensure optimum crew performance, entire crews along with their visiting crews should be selected collectively, rather than individually.

[Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study?].

PubMed

Lee, Su Hyun; Jung, Jin Tae; Lee, Dong Wook; Ha, Chang Yoon; Park, Kyung Sik; Lee, Si Hyung; Yang, Chang Heon; Park, Youn Sun; Jeon, Seong Woo

2015-08-01

Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n = 62), hemoclipping only; group 2 (n = 88), hemoclipping plus epinephrine injection; and group 3 (n = 36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p <œ 0.001). However, primary outcomes (rebleeding, other management, morbidity, hospitalization period, fasting period and mortality) and secondary outcomes (bleeding associated mortality and total mortality) were not different among groups. Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.

Effect of vasoconstriction on pain after mandibular third molar surgery: A single-blind, randomized controlled trial.

PubMed

Martin, Wilhelmus J J M; Skorpil, Nynke E; Ashton-James, Claire E; Tuinzing, D Bram; Forouzanfar, Tymour

2016-01-01

Previous research has demonstrated the efficacy of using local compression to reduce postoperative pain after third molar surgery. It has been theorized that compression reduces pain intensity through vasoconstriction. The current research tests the veracity of this vasoconstriction hypothesis by testing the impact of local epinephrine (a local vasoconstrictor) versus a control on patients' pain ratings over 7 days following surgery. Fifty patients scheduled for mandibular third molar surgery were randomly assigned to receive one cartridge of Ultracaine DS Forte (the treatment group) or one cartridge of Ultracaine DS (the control group) after surgical removal of the third molar. Participants used the visual analog scale (VAS) to provide daily ratings of pain intensity for 7 days following surgery. In addition, on day 7, the perceived effectiveness of the pain treatment was measured with the global perceived effect (GPE) scale. A quality- of-life questionnaire was also completed. A repeated-measures ANOVA indicated that the treatment group perceived significantly less pain than the control group on days 2 to 7 following surgery. In addition, 77.8% of the treatment group perceived their pain treatment to be successful, while only 69.6% of the control group reported that their pain was reduced successfully by day 7. The results of this study provide an initial proof of concept that epinephrine may have an analgesic effect on the period following third molar surgery. Further research with larger sample sizes is needed to strengthen evidence for the clinical utility of offering localized epinephrine to patients following third molar surgery.

Metabolic Inflexibility in Substrate Use Is Present in African-American But Not Caucasian Healthy, Premenopausal, Nondiabetic Women

PubMed Central

Berk, Evan S.; Kovera, Albert J.; Boozer, Carol N.; Pi-Sunyer, F. Xavier; Albu, Jeanine B.

2009-01-01

Context There is an increased prevalence of obesity and insulin resistance in African-American compared with Caucasian females. Metabolic inflexibility (MI) is the inability to switch the use of lipids and carbohydrates in the peripheral tissue (i.e. muscle) based upon substrate availability. Objective We examined whether MI exists in African-American females. Main Outcome Measures and Design We measured substrate use differences during eucaloric, macronutrient-manipulated diets [high fat (50% fat, 35% carbohydrate, 15% protein) vs. low fat (30% fat, 55% carbohydrate, 15% protein)] between Caucasian and African-American women. We also compared differences in substrate use in response to insulin infusion during two-step pancreatic-euglycemic clamps and epinephrine infusion during lipolysis studies. In each study, similar groups of Caucasian and African-American women were compared. Results Caucasians had significantly higher fat oxidation (FO) (P = 0.01) and lower carbohydrate oxidation (P < 0.01) during the high-fat vs. low-fat diet, whereas no significant differences were observed in African-Americans. The African-American women also failed to significantly suppress FO during the second step of the pancreatic-euglycemic clamp despite a doubling of their fasting plasma insulin and failed to increase their FO or decrease their carbohydrate oxidation in response to epinephrine infusion as much as Caucasian women did. The response of free fatty acid turnover rates to insulin and epinephrine stimulation was similar between races. Conclusion The impaired substrate use observed in African-American women during these three studies demonstrates the existence of MI and may contribute to their greater prevalence of obesity and insulin resistance. PMID:16868062

Bronchodilatory and B-adrenergic effects of methanolic and aqueous extracts of Althaea root on isolated tracheobronchial smooth rat muscle.

PubMed

Alani, Behrang; Zare, Mohammad; Noureddini, Mahdi

2015-01-01

The smooth muscle contractions of the tracheobronchial airways are mediated through the balance of adrenergic, cholinergic and peptidergic nervous mechanisms. This research was designed to determine the bronchodilatory and B-adrenergic effects of methanolic and aqueous extracts of root Althaea on the isolated tracheobronchial smooth muscle of the rat. In this experimental study, 116 tracheobronchial sections (5 mm) from 58 healthy male Sprague-Dawley rats were dissected and divided into 23 groups. The effect of methanolic and aqueous extracts of the root Althaea was assayed at different concentrations (0.2, 0.6, 2.6, 6.6, 14.6 μg/ml) and epinephrine (5 μm) in the presence and absence of propranolol (1 μM) under one g tension based on the isometric method. This assay was recorded in an organ bath containing Krebs-Henseleit solution for tracheobronchial smooth muscle contractions using potassium chloride (KCl) (60 mM) induction. Epinephrine (5 μm) alone and root methanolic and aqueous extract concentrations (0.6-14.6 μg/ml) reduced tracheobronchial smooth muscle contractions induced using KCl (60 mM) in a dose dependent manner. Propranolol inhibited the antispasmodic effect of epinephrine on tracheobronchial smooth muscle contractions, but could not reduce the antispasmodic effect of the root extract concentrations. The methanolic and aqueous extracts of Althaea root inhibited the tracheobronchial smooth muscle contractions of rats in a dose dependent manner, but B-adrenergic receptors do not appear to engage in this process. Understanding the mechanism of this process can be useful in the treatment of pulmonary obstructive diseases like asthma.

Food allergy prevalence and management at an overnight summer camp.

PubMed

Redmond, Margaret; Kempe, Erin; Strothman, Kasey; Wada, Kara; Scherzer, Rebecca; Stukus, David R

2016-06-01

In recent years, increased awareness of food allergy management has focused on the school setting. A lack of awareness and relevant literature prompted evaluation of the camp experience. To characterize the prevalence of food allergies among children attending an overnight summer camp and to evaluate the knowledge and comfort of camp personnel before and after a training session. The database for the 2014 season at Flying Horse Farms was reviewed for information pertaining to food allergies and provision of epinephrine and treatment plans. Camp personnel completed surveys regarding food allergy knowledge and comfort. Surveys were redistributed 30 days after the training session. Among 445 campers, 15% reported at least one food allergy, with 8.5% reporting allergy to 1 of the top 8 food allergens. Only 32% of campers with food allergy supplied an epinephrine autoinjector, and 0% provided written treatment plans. Before training, 84% of personnel desired additional information about food allergies. Knowledge of food allergies among personnel was high at baseline but increased after training in regard to epinephrine use for anaphylaxis and postepinephrine management. Staffers who reported feeling very comfortable caring for campers with food allergy increased from 16% to 46% after the training session; comfort in treating a food allergy emergency increased from 2% to 29%. Management of food allergies at overnight summer camps warrants similar education and preparation strategies as those implemented in schools. Camp personnel should receive annual training regarding food allergies and anaphylaxis. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Epinephrine Injection

MedlinePlus

... of the thigh, and can be injected through clothing if necessary in an emergency. If you are ... Keep this medication in the plastic carrying tube it came in, tightly closed, and out of reach of children. Keep it at room temperature and away from ...

21 CFR 500.65 - Epinephrine injection 1:1,000 in 10-milliliter containers for emergency treatment of...

Code of Federal Regulations, 2011 CFR

2011-04-01

... symptoms of anaphylactoid shock including glassy eyes, increased salivation, grinding of the teeth, rapid... treating anaphylactoid shock. Usual Dosage: Cattle, horses, sheep, and swine—1 cubic centimeter per 100...

21 CFR 500.65 - Epinephrine injection 1:1,000 in 10-milliliter containers for emergency treatment of...

Code of Federal Regulations, 2010 CFR

2010-04-01

... symptoms of anaphylactoid shock including glassy eyes, increased salivation, grinding of the teeth, rapid... treating anaphylactoid shock. Usual Dosage: Cattle, horses, sheep, and swine—1 cubic centimeter per 100...

Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery.

PubMed

Ping, Bushara; Kiattavorncharoen, Sirichai; Durward, Callum; Im, Puthavy; Saengsirinavin, Chavengkiat; Wongsirichat, Natthamet

2015-09-01

The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

Coagulation parameters and platelet function analysis in patients with acromegaly.

PubMed

Colak, A; Yılmaz, H; Temel, Y; Demirpence, M; Simsek, N; Karademirci, İ; Bozkurt, U; Yasar, E

2016-01-01

Acromegaly is associated with increased cardiovascular morbidity and mortality. The data about the evaluation of coagulation and fibrinolysis in acromegalic patients are very limited and to our knowledge, platelet function analysis has never been investigated. So, we aimed to investigate the levels of protein C, protein S, fibrinogen, antithrombin 3 and platelet function analysis in patients with acromegaly. Thirty-nine patients with active acromegaly and 35 healthy subjects were included in the study. Plasma glucose and lipid profile, fibrinogen levels, GH and IGF-1 levels and protein C, protein S and antithrombin III activities were measured in all study subjects. Also, platelet function analysis was evaluated with collagen/ADP and collagen-epinephrine-closure times. Demographic characteristics of the patient and the control were similar. As expected, fasting blood glucose levels and serum GH and IGF-1 levels were significantly higher in the patient group compared with the control group (pglc: 0.002, pGH: 0.006, pIGF-1: 0.001, respectively). But lipid parameters were similar between the two groups. While serum fibrinogen and antithrombin III levels were found to be significantly higher in acromegaly group (p fibrinogen: 0.005 and pantithrombin III: 0.001), protein S and protein C activity values were significantly lower in the patient group (p protein S: 0.001, p protein C: 0.001). Also significantly enhanced platelet function (measured by collagen/ADP- and collagen/epinephrine-closure times) was demonstrated in acromegaly (p col-ADP: 0.002, p col-epinephrine: 0.002). The results did not change, when we excluded six patients with type 2 diabetes in the acromegaly group. There was a negative correlation between serum GH levels and protein S (r: -0.25, p: 0.04)) and protein C (r: -0.26, p: 0.04) values. Likewise, there was a negative correlation between IGF-1 levels and protein C values (r: -0.39, p: 0.002), protein S values (r: -0.39, p: 0.001), collagen/ADP-closure times (r: -0.28, p: 0.02) and collagen/epinephrine-closure times (r:-0.26, p: 0.04). Also, we observed a positive correlation between IGF-1 levels and fibrinogen levels (r: 0.31, p: 0.01). Acromegaly was found to be associated with increased tendency to coagulation and enhanced platelet activity. This hypercoagulable state might increase the risk for cardiovascular and cerebrovascular events in acromegaly.

Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?

PubMed

Jayamali, W D; Herath, H M M T B; Kulathunga, Aruna

2017-09-04

Anaphylaxis is an acute, potentially fatal medical emergency. Myocardial injury or infarction in the setting of an anaphylaxis can be due the anaphylaxis itself, when it is known as Kounis syndrome or it can also be due to the effect of epinephrine treatment. Epinephrine is considered as the cornerstone in management of anaphylaxis. Myocardial infarction secondary to therapeutic doses of adrenaline is a rare occurrence and only a few cases have been reported in literature. The mechanism of myocardial injury was considered to be due to coronary vasospasm secondary to epinephrine as the coronary angiograms were normal on these occasions. A 21-year- old previously healthy male got admitted to the local hospital with an urticarial rash and difficulty in breathing, one hour after ingestion of prawns for which he was known to be allergic. He was treated with 0.5 ml of intramuscular adrenaline (1:1000) which was administered to the lateral side of the thigh, following which he developed palpitations and tightening type central chest pain. Electrocardiogram showed ST segment depressions in leads III, aVF and V1 to V5 and he was transferred to a tertiary care hospital. The second electrocardiogram, done 2 h later, showed resolution of ST segment depressions but new T inversions in leads I and aVL. Troponin I was elevated with a titer of 2.15 ng/ml. He was treated with sublingual GTN in the emergency treatment unit and the symptoms resolved. Transthoracic 2D echocardiogram and stress testing with treadmill was normal and CT coronary angiogram revealed normal coronary arteries. Here we present a case of a young healthy adult with no significant risk factors for coronary artery disease who developed myocardial infarction following intramuscular administration of therapeutic dose of adrenalin for an anaphylactic reaction. The postulated mechanism is most likely an alpha receptor mediated coronary vascular spasm. However the use of adrenaline in the setting of life threatening anaphylaxis is life saving and the benefits far outweigh the risks of adverse effects. Therefore the purpose of reporting this case is not to discourage the use of adrenaline in anaphylaxis but to make aware of this potential adverse effect which can occur in the acute setting.

Effects of perch access on physiological parameters in caged White Leghorn pullets

USDA-ARS?s Scientific Manuscript database

The neuroendocrine system controls animals' adaptability to their environments by releasing psychotropic compounds such as catecholamines [epinephrine (EP), norepinephrine (NE), and dopamine (DA)], corticosterone (CORT), and serotonin (5-HT). Changes of these neuroendocrine compounds have been used ...

Stress in air traffic controllers : a restudy of 32 controllers 5 to 9 years later.

DOT National Transportation Integrated Search

1978-10-01

Thirty-two subjects who had participated in air traffic controller stress studies 5-9 years earlier were restudied with regard to urinary excretion of 17-ketogenic steroids, epinephrine, and norepinephrine. All subjects showed decreases in excretion ...

Adrenergic and steroid hormone modulation of ozone-induced pulmonary injury and inflammation

EPA Science Inventory

Rationale: We have shown that acute ozone inhalation promotes activation of the sympathetic and hypothalamic-pituitary-adrenal (HPA) axis leading to release of cortisol and epinephrine from the adrenals. Adrenalectomy (ADREX) inhibits ozone-induced pulmonary vascular leakage and ...

Effects of Nicotine Withdrawal in Adult Male and Female Rats

DTIC Science & Technology

2008-01-01

acid (GABA), norepinephrine, epinephrine, and beta-endorphin in the brain ( Barik & Wonnacott, 2006; Koob & LeMoal, 2006). Marked nicotine withdrawal...and Evaluation in Counseling and Development, 58-90. Barik , J., & Wonnacott, S. (2006). Indirect modulation by alpha7 nicotinic acetylcholine receptors

Long Acting β2 Adrenergic Potentiates Ozone-Induced Lung Injury and Inflammation

EPA Science Inventory

Ozone (O3), a ubiquitous air pollutant, disproportionately affects asthmatics. We have shown that O3-induced lung injury and inflammation are associated with increased circulating epinephrine and corticosterone, and inhibiting β adrenergic receptors (AR) and glucocor...

Temperament dictates endotoxin-induced metabolic changes in Brahman bulls

USDA-ARS?s Scientific Manuscript database

We previously reported that animal temperament influences the rectal temperature response, sickness behavior scores, serum concentrations of epinephrine (Burdick et al., 2011; Innate Immunity), and serum cytokine concentrations (Hulbert et al., 2009; J. Anim. Sci. 86 (Suppl 2):527) following a provo...

Ozone-Induced Metabolic Impairment is Attenuated in Adrenalectomized Wistar Kyoto Rats

EPA Science Inventory

Rationale: Air pollutants have been linked to increased incidence of metabolic syndrome however the mechanisms are poorly understood. We have recently shown that ozone exposure induces significant hyperglycemia together with elevated serum leptin and epinephrine in the Wistar Ky...

Effect of Sodium Bicarbonate Buccal Infiltration on the Success of Inferior Alveolar Nerve Block in Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Double-blind Study.

PubMed

Saatchi, Masoud; Farhad, Ali Reza; Shenasa, Naghmeh; Haghighi, Saeideh Karimi

2016-10-01

The purpose of this prospective, randomized, double-blind study was to evaluate the effect of a buccal infiltration of sodium bicarbonate on the anesthetic success of the inferior alveolar nerve block (IANB) for mandibular first molars in patients with symptomatic irreversible pulpitis. One hundred patients diagnosed with symptomatic irreversible pulpitis of a mandibular first molar were selected. The patients randomly received a buccal infiltration injection of either 0.7 mL 8.4% sodium bicarbonate with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine or 0.7 mL sterile distilled water with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine in a double-blind manner. After 15 minutes, all the patients received conventional IANB injection using 3.6 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after the IANB injection. Lip numbness was a requisite for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed using the t, chi-square and Mann-Whitney U tests. The success rate after the buccal infiltration of sodium bicarbonate was 78%, whereas without the buccal infiltration of sodium bicarbonate it was 44% (P < .001). A buccal infiltration of 0.7 mL 8.4% sodium bicarbonate increased the success rate of IANBs in mandibular first molars with symptomatic irreversible pulpitis. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Development and Prospective Federal State-Wide Evaluation of a Device for Height-Based Dose Recommendations in Prehospital Pediatric Emergencies: A Simple Tool to Prevent Most Severe Drug Errors.

PubMed

Kaufmann, Jost; Roth, Bernhard; Engelhardt, Thomas; Lechleuthner, Alex; Laschat, Michael; Hadamitzky, Christoph; Wappler, Frank; Hellmich, Martin

2018-01-01

Drug dosing errors pose a particular threat to children in prehospital emergency care. With the Pediatric emergency ruler (PaedER), we developed a simple height-based dose recommendation system and evaluated its effectiveness in a pre-post interventional trial as the Ethics Committee disapproved randomization due to the expected positive effect of the PaedER on outcome. Pre-interventional data were retrospectively retrieved from the electronic records and medical protocols of the Cologne Emergency Medical Service over a two-year period prior to the introduction of the PaedER. Post-interventional data were collected prospectively over a six-year period in a federal state-wide open trial. The administered doses of either intravenous or intraosseous fentanyl, midazolam, ketamine or epinephrine were recorded. Primary outcome measure was the number and severity of drug dose deviation from recommended dose (DRD) based on the patient's weight. Fifty-nine pre-interventional and 91 post-interventional prehospital drug administrations in children were analyzed. The rate of DRD > 300% overall medications were 22.0% in the pre- and 2.2% in the post-interventional group (p < 0.001). All administrations of epinephrine occurred excessive (DRD > 300%) in pre-interventional and none in post-interventional patients (p < 0.001). The use of the PaedER resulted in a 90% reduction of medication errors (95% CI: 57% to 98%; p < 0.001) and prevented all potentially life-threatening errors associated with epinephrine administration. There is an urgent need to increase the safety of emergency drug dosing in children during emergencies. A simple height-based system can support health care providers and helps to avoid life-threatening medication errors.

The effects of vasoactive agents on flow through saphenous vein grafts during lower-extremity peripheral vascular surgery.

PubMed

Maslow, Andrew D; Bert, Arthur; Slaiby, Jeffrey; Carney, William; Marcaccio, Edward

2007-06-01

The purpose of this study was to assess the effects of hemodynamic alterations on vein graft flow during peripheral vascular surgery. It was hypothesized that vasopressors can be administered without compromising flow through the vein grafts. Tertiary care center, university medical center. Randomized placebo-controlled double-blinded study. The effects of phenylephrine, epinephrine, milrinone, intravenous fluid, and placebo on newly constructed peripheral vein grafts were assessed in 60 patients (12 patients in each of 5 groups). Systemic and central hemodynamics were measured by using intra-arterial and pulmonary artery catheters. Vein graft flow was measured by using a transultrasonic flow probe (Transultrasonic Inc, Ithaca, NY). Phenylephrine increased systemic mean blood pressure (mBP) (68.2-94.0 mmHg, p < 0.01), systemic vascular resistance (SVR) (1,091-1,696 dynes x sec x cm(-5), p < 0.001), and vein graft flow (39.5-58.9 mL/min, p < 0.01), whereas cardiac output remained unchanged. Epinephrine resulted in increased cardiac output (4.4-6.9 L/min, p < 0.01) and mBP (72.7-89.1 mmHg, p < 0.01), whereas vein graft flow was reduced in 6 of 12 patients. Intravenous fluid administration resulted in a relatively smaller increase in graft flow (37.6-46.0 mL/min, p < 0.05), an increase in cardiac output, and an insignificant decrease in SVR. Other treatments had either little or no effect on vein graft flow. The study hypothesis was partly supported. Although both phenylephrine and epinephrine increased blood pressure, only the former increased vein graft flow in all patients. In conjunction with increases in graft flow after fluid administration, these data suggest that factors affecting vein graft flow are not just simply related to systemic hemodynamics.

The effect of intraosseous local anesthesia of 4% articaine with 1:100,000 epinephrine on pulpal blood flow and pulpal anesthesia of mandibular molars and canines.

PubMed

Vongsavan, Kadkao; Samdrup, Tshering; Kijsamanmith, Kanittha; Rirattanapong, Praphasri; Vongsavan, Noppakun

2018-05-10

The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects. Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT). IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P < 0.001). The percentage reduction in PBF was 60% after 1 min and PBF returned back to the baseline after 45 min. No significant reduction in PBF was observed in the canines (P = 0.212). For pulpal anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved. IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur. IO anesthesia is safe to use as a primary technique in teeth with normal pulp.

Are Registration of Disease Codes for Adult Anaphylaxis Accurate in the Emergency Department?

PubMed Central

Choi, Byungho; Lee, Hyeji

2018-01-01

Purpose There has been active research on anaphylaxis, but many study subjects are limited to patients registered with anaphylaxis codes. However, anaphylaxis codes tend to be underused. The aim of this study was to investigate the accuracy of anaphylaxis code registration and the clinical characteristics of accurate and inaccurate anaphylaxis registration in anaphylactic patients. Methods This retrospective study evaluated the medical records of adult patients who visited the university hospital emergency department between 2012 and 2016. The study subjects were divided into the groups with accurate and inaccurate anaphylaxis codes registered under anaphylaxis and other allergy-related codes and symptom-related codes, respectively. Results Among 211,486 patients, 618 (0.29%) had anaphylaxis. Of these, 161 and 457 were assigned to the accurate and inaccurate coding groups, respectively. The average age, transportation to the emergency department, past anaphylaxis history, cancer history, and the cause of anaphylaxis differed between the 2 groups. Cutaneous symptom manifested more frequently in the inaccurate coding group, while cardiovascular and neurologic symptoms were more frequently observed in the accurate group. Severe symptoms and non-alert consciousness were more common in the accurate group. Oxygen supply, intubation, and epinephrine were more commonly used as treatments for anaphylaxis in the accurate group. Anaphylactic patients with cardiovascular symptoms, severe symptoms, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes. Conclusions In case of anaphylaxis, more patients were registered inaccurately under other allergy-related codes and symptom-related codes rather than accurately under anaphylaxis disease codes. Cardiovascular symptoms, severe symptoms, and epinephrine treatment were factors associated with accurate registration with anaphylaxis disease codes in patients with anaphylaxis. PMID:29411554

Evidence that central dopamine receptors modulate sympathetic neuronal activity to the adrenal medulla to alter glucoregulatory mechanisms.

PubMed

Arnerić, S P; Chow, S A; Bhatnagar, R K; Webb, R L; Fischer, L J; Long, J P

1984-02-01

Previous reports suggest that analogs of dopamine (DA) can produce hyperglycemia in rats by interacting with DA receptors. Experiments reported here indicate the site of action and describe the metabolic sequalae associated with the hyperglycemic effect of apomorphine (APO), produced in conscious unrestrained rats. Apomorphine was more potent when administered by intracerebroventricular (i.c.v.) injection than when given subcutaneously (s.c.). Very small doses of the DA receptor antagonist pimozide, given intraventricularly, blocked the hyperglycemic effect of apomorphine administered subcutaneously. Sectioning of the spinal cord at thoracic vertebra T1-2 or sectioning the greater splanchnic nerve blocked apomorphine-induced hyperglycemia; whereas section of the superior colliculus or section at T5-6 had no effect. A dose of apomorphine or epinephrine (EPI) producing a similar degree of hyperglycemia elevated the concentration of EPI in serum to a similar degree, and the increase in EPI in serum preceded the increase in glucose in serum. Fasting animals for 2 or 18 hr had no significant effect on EPI- or apomorphine-induced hyperglycemia despite a reduction (91-93%) of the glycogen content of liver and skeletal muscle during the 18 hr fast. 5-Methoxyindole-2-carboxylic acid (MICA), an inhibitor of gluconeogenesis, blocked EPI- and apomorphine-induced hyperglycemia in rats fasted for 18 hr. However, 5-methoxyindole-2-carboxylic acid was ineffective in blocking hyperglycemia in animals fasted for 2 hr. Changes in insulin or glucagon in serum alone cannot account for the hyperglycemic action of apomorphine. These data demonstrate that apomorphine interacts with central DA receptors located in the hindbrain to activate sympathetic neuronal activity to the adrenal gland which subsequently releases epinephrine to alter homeostasis of glucose. Epinephrine may then, depending on the nutritional status, facilitate glycogenolytic or gluconeogenic processes to produce hyperglycemia.

Effects of adrenalectomy on the alpha-adrenergic regulation of cytosolic free calcium in hepatocytes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Freudenrich, C.C.; Borle, A.B.

1988-06-25

We have previously published that bilateral adrenalectomy in the rat reduces the Ca2+-mediated alpha-adrenergic activation of hepatic glycogenolysis, while it increases the cellular calcium content of hepatocytes. In the experiments presented here, the concentration of cytosolic free calcium (Ca2+i) at rest and in response to epinephrine was measured in aequorin-loaded hepatocytes isolated from sham and adrenalectomized male rats. We found that in adrenalectomized rats the resting Ca2+i was elevated, the rise in Ca2+i evoked by epinephrine was reduced, and the rise in /sup 45/Ca efflux that follows such stimulation was depressed. Furthermore, the slope of the relationship between Ca2+i andmore » calcium efflux was decreased 60% in adrenalectomized. Adrenalectomy did not change Ca2+ release from intracellular calcium pools in response to IP3 in saponin-permeabilized hepatocytes. The EC50 for inositol 1,4,5-triphosphate and the maximal Ca2+ released were similar in both sham and adrenalectomized animals. Finally, the liver calmodulin content determined by radioimmunoassay was not significantly different between sham and adrenalectomized rats. These results suggest that 1) adrenalectomy reduces calcium efflux from the hepatocyte, probably by an effect on the plasma membrane (Ca2+-Mg2+)-ATPase-dependent Ca2+ pump and thus alters cellular calcium homeostasis; 2) adrenalectomy decreases the rise in Ca2+i in response to epinephrine; 3) this decreased rise in Ca2+i is not due to defects in the intracellular Ca2+ storage and mobilization processes; and 4) the effects of adrenalectomy on cellular calcium metabolism and on alpha-adrenergic activation of glycogenolysis are not caused by a reduction in soluble calmodulin.« less

Implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) for Food Challenges.

PubMed

Simberloff, Tander; Parambi, Ron; Bartnikas, Lisa M; Broyles, Ana Dioun; Hamel, Victoria; Timmons, Karol G; Miller, D Marlowe; Graham, Dionne A; Schneider, Lynda C; MacGinnitie, Andrew J

Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs. The objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients. Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions. Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location. By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Effects of commonly used inotropes on myocardial function and oxygen consumption under constant ventricular loading conditions

PubMed Central

DeWitt, Elizabeth S.; Black, Katherine J.; Thiagarajan, Ravi R.; DiNardo, James A.; Colan, Steven D.; McGowan, Francis X.

2016-01-01

Inotropic medications are routinely used to increase cardiac output and arterial blood pressure during critical illness. However, few comparative data exist between these medications, particularly independent of their effects on venous capacitance and systemic vascular resistance. We hypothesized that an isolated working heart model that maintained constant left atrial pressure and aortic blood pressure could identify load-independent differences between inotropic medications. In an isolated heart preparation, the aorta and left atrium of Sprague Dawley rats were cannulated and placed in working mode with fixed left atrial and aortic pressure. Hearts were then exposed to common doses of a catecholamine (dopamine, epinephrine, norepinephrine, or dobutamine), milrinone, or triiodothyronine (n = 10 per dose per combination). Cardiac output, contractility (dP/dtmax), diastolic performance (dP/dtmin and tau), stroke work, heart rate, and myocardial oxygen consumption were compared during each 10-min infusion to an immediately preceding baseline. Of the catecholamines, dobutamine increased cardiac output, contractility, and diastolic performance more than clinically equivalent doses of norepinephrine (second most potent), dopamine, or epinephrine (P < 0.001). The use of triiodothyronine and milrinone was not associated with significant changes in cardiac output, contractility or diastolic function, either alone or added to a baseline catecholamine infusion. Myocardial oxygen consumption was closely related to dP/dtmax (r2 = 0.72), dP/dtmin (r2 = 0.70), and stroke work (r2 = 0.53). In uninjured, isolated working rodent hearts under constant ventricular loading conditions, dobutamine increased contractility and cardiac output more than clinically equivalent doses of norepinephrine, dopamine, and epinephrine; milrinone and triiodothyronine did not have significant effects on contractility. PMID:27150829

Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans.

PubMed

Kox, Matthijs; van Eijk, Lucas T; Zwaag, Jelle; van den Wildenberg, Joanne; Sweep, Fred C G J; van der Hoeven, Johannes G; Pickkers, Peter

2014-05-20

Excessive or persistent proinflammatory cytokine production plays a central role in autoimmune diseases. Acute activation of the sympathetic nervous system attenuates the innate immune response. However, both the autonomic nervous system and innate immune system are regarded as systems that cannot be voluntarily influenced. Herein, we evaluated the effects of a training program on the autonomic nervous system and innate immune response. Healthy volunteers were randomized to either the intervention (n = 12) or control group (n = 12). Subjects in the intervention group were trained for 10 d in meditation (third eye meditation), breathing techniques (i.a., cyclic hyperventilation followed by breath retention), and exposure to cold (i.a., immersions in ice cold water). The control group was not trained. Subsequently, all subjects underwent experimental endotoxemia (i.v. administration of 2 ng/kg Escherichia coli endotoxin). In the intervention group, practicing the learned techniques resulted in intermittent respiratory alkalosis and hypoxia resulting in profoundly increased plasma epinephrine levels. In the intervention group, plasma levels of the anti-inflammatory cytokine IL-10 increased more rapidly after endotoxin administration, correlated strongly with preceding epinephrine levels, and were higher. Levels of proinflammatory mediators TNF-α, IL-6, and IL-8 were lower in the intervention group and correlated negatively with IL-10 levels. Finally, flu-like symptoms were lower in the intervention group. In conclusion, we demonstrate that voluntary activation of the sympathetic nervous system results in epinephrine release and subsequent suppression of the innate immune response in humans in vivo. These results could have important implications for the treatment of conditions associated with excessive or persistent inflammation, such as autoimmune diseases.

Glucose counterregulation, hypoglycemia, and intensive insulin therapy in diabetes mellitus.

PubMed

Cryer, P E; Gerich, J E

1985-07-25

The prevention or correction of hypoglycemia is the result of both dissipation of insulin and activation of counterregulatory systems. In the models studied to date, glucagon and epinephrine have been shown to be the key counterregulatory factors; the potential roles of other hormones, neural factors, or substrate mechanisms in other models and during more gradual recovery from hypoglycemia remain to be defined. Deficient glucagon responses to decrements in plasma glucose, which are common in patients with IDDM and occur in some patients with NIDDM, result in altered counterregulation. But counterregulation is generally adequate, because epinephrine compensates for it. Defective glucose counterregulation due to combined deficiencies of glucagon and epinephrine secretory responses occurs in many patients, typically those with longstanding diabetes, and must be added to the list of factors known to increase the risk of hypoglycemia, at least during intensive therapy. From the material reviewed, it should be apparent that much has been learned about glucose counterregulation. It should be equally clear that much remains to be learned. Among the many possibilities, we consider four worthy of emphasis. First of all, we need to examine the physiology and pathophysiology of glucose counterregulation in additional models (e.g., during exercise) and over longer periods. Secondly, we need to determine whether central nervous system adaptation to antecedent glycemia occurs and, if so, identify its mechanisms. Thirdly, we need to develop better methods of insulin delivery or learn to correct or compensate for defective counterregulatory systems, if we are to achieve euglycemia safely in diabetic patients with defective glucose counterregulation. Finally, we need to know whether effective control of diabetes mellitus prevents development of defective glucose counterregulation.

Severe contrast reaction emergencies high-fidelity simulation training for radiology residents and technologists in a children's hospital.

PubMed

Tofil, Nancy M; White, Marjorie Lee; Grant, Matthew; Zinkan, J Lynn; Patel, Bhavik; Jenkins, Lynsey; Youngblood, Amber Q; Royal, Stuart A

2010-07-01

Severe reactions to radiographic contrast agents can be life threatening, and although they are rare, effective recognition and management are essential to improving outcomes. A high-fidelity radiology simulation course for radiology residents and technologists focusing on severe contrast reactions and immediate treatments was designed to test the hypothesis that knowledge would improve with this educational intervention. A prospective pretest and posttest study design was used. Residents and technologists worked in teams of three to five members. Learning objectives focused on demonstrating when and how to use basic life support skills and epinephrine auto-injectors. Each resident and technologist was administered a pretest prior to the start of the case scenarios and a posttest following the debriefing session. Scores from the pretest and posttest for the residents and technologists were compared using a paired-samples t test. Nineteen radiology residents and 11 radiology technologists participated. The average test scores were higher and improved significantly following the simulation experience for both the radiology residents (57% vs 82%, P < .001) and technologists (47% vs 72%, P = .006). Anonymous evaluations demonstrated that the experience was well received by residents and technologists, with 97% of learners (29 of 30) rating the experience as extremely or very helpful. Important learning themes included the knowledge of epinephrine auto-injector use and basic life support skills. High-fidelity simulation for radiology residents and technologists focusing on epinephrine auto-injector use and basic life support skills during the first 5 minutes of a severe contrast reaction can significantly improve recognition and knowledge in treating patients having severe contrast reactions. 2010 AUR. Published by Elsevier Inc. All rights reserved.

Skeletal muscle PLIN3 and PLIN5 are serine phosphorylated at rest and following lipolysis during adrenergic or contractile stimulation

PubMed Central

MacPherson, Rebecca E K; Vandenboom, Rene; Roy, Brian D; Peters, Sandra J

2013-01-01

In adipose tissue, access of adipose triglyceride and hormone-sensitive lipases (ATGL and HSL) to the lipid droplet depends on PLIN1 phosphorylation, however, PLIN1 is not expressed in skeletal muscle and the phosphorylation of the expressed PLINs has yet to be investigated. Further, direct interactions between skeletal muscle PLINs and HSL are unknown. We investigated the isolated and combined effects of epinephrine and contraction on PLIN-to-lipase interactions as well as phosphorylation. Isolated rat solei were assigned to one of four 30 min in vitro conditions (25°C): (1) rest; (2) intermittent tetanic stimulation (60 Hz for 150 msec; train rate 20/min); (3) 5 nmol/L epinephrine; (4) intermittent tetanic stimulation and 5 nmol/L epinephrine. Immunoprecipitation of serine phosphorylated proteins followed by Western blotting for PLIN2, PLIN3, PLIN5, revealed that only PLIN2 is not phosphorylated under any of the experimental conditions. This is the first study to show that in whole rat skeletal muscle PLIN3 and PLIN5 are serine phosphorylated. The degree of serine phosphorylation remained unchanged following adrenergic and/or contractile stimulation. Oil red O staining of muscle sections for lipid content shows a significant decrease following each condition, confirming lipolysis occurred (P < 0.05). PLIN2, 3, and 5 all interact with HSL and ATGL, but these interactions were unchanged following treatments. Our results show that in skeletal muscle, PLIN2 is not serine phosphorylated at rest or with lipolytic stimulation and that while PLIN3, PLIN5 are serine phosphorylated at rest, the degree of phosphorylation does not change with lipolytic stimulation. PMID:24303154

In vivo suppression of plasma IL-12 levels by acute and chronic stress paradigms: potential mediating mechanisms and sex differences

PubMed Central

Shaashua, L.; Sominsky, L.; Levi, B.; Sorski, L.; Reznick, M.; Page, G.; Ben-Eliyahu, S.

2012-01-01

Interleukin-12 (IL-12) is a major pro-inflammatory cytokine, which promotes cell-mediated immunity and TH1 differentiation. In vitro studies indicated suppression of IL-12 production by several stress-related factors, but no effects of behavioral stress were shown on plasma IL-12 levels. Therefore, in the current study we (i) examined the in vivo effects of various behavioral and pharmacological stress paradigms on baseline plasma IL-12 levels; (ii) compared these in vivo findings to those obtained following in vitro stimulation of leukocytes from the same rats; and (iii) assessed potential sexual dimorphism in these outcomes. The findings indicated that plasma IL-12 levels were significantly reduced by social confrontation, wet-cage exposure, surgery, and the administration of corticosterone, epinephrine, or prostaglandin-E2. Notably, most in vivo impacts on plasma levels were not evident when assessed in vitro. The IL-12-reducing effects of wet-cage exposure, and of corticosterone and epinephrine administration, were significantly greater in males than in females, although females exhibited greater total corticosterone levels following stress. The duration of acute stressors predicted the degree of IL-12 reduction, but more prolonged stressors did not. Furthermore, seven days of alternating behavioral stressors reduced plasma IL-12 levels more than fourteen days. These findings suggest animals’ behavioral habituation to stress conditions, or a specific immune mechanism restricting the duration of IL-12 reduction. Overall, our findings indicate a generic and robust stress-induced reduction in plasma IL-12 levels, and suggest epinephrine, corticosterone, and prostaglandin-E2, as potential mediators that should be scrutinized in vivo in the context of natural physiological stress responses. PMID:22659252

Behavioral and perceived stressor effects on urinary catecholamine excretion in adult Samoans.

PubMed

Bergey, Meredith R; Steele, Matthew S; Bereiter, David A; Viali, Satupaitea; McGarvey, Stephen T

2011-01-01

The effects of perceptions and behaviors related to culturally patterned socioeconomic obligations on catecholamine excretion rates were studied in a cross-sectional sample of Samoan adults. A total of 378 participants, ages 29-62 years, from 9 villages throughout Samoa, provided timed overnight urine specimens, and self-reported perceptions and behaviors associated with contributions to one's family, aiga, and chief, matai, and communal gift exchanges, fa'alavelave. Urinary norepinephrine and epinephrine excretion rates were measured by high performance liquid chromatography with electrochemical detection. Age (≤40 vs. >40 years) and gender-specific regression models were estimated to detect associations with catecholamine excretion. Young women who contribute more to their matai, who consider fa'alavelave to be a financial strain, and who view their contribution to their matai to be "just right," had significantly higher residence-adjusted norepinephrine excretion. Young women who contribute more to their matai, who consider fa'alavelave to be a financial strain, and who consider their contribution to their aiga not to be a burden, had higher epinephrine excretion. Older men who contribute more to their aiga and who perceive their contribution to their aiga to be "just right" had increased residence-adjusted epinephrine excretion. Individual-level perceptions and behaviors related to traditional socioeconomic obligations are a significant correlate of increased overnight catecholamine excretion rates. Higher excretion rates may be attributed to psychosocial stress arousal associated with a discordance between personal desires for upward social mobility, and family and community-based socioeconomic obligations. Changes in patterns of individual-level psychosocial stress arousal may contribute to cardiovascular disease risk in modernizing Samoans. Copyright © 2011 Wiley-Liss, Inc.

The misleading nature of in vitro and ex vivo findings in studying the impact of stress hormones on NK cell cytotoxicity.

PubMed

Gotlieb, Neta; Rosenne, Ella; Matzner, Pini; Shaashua, Lee; Sorski, Liat; Ben-Eliyahu, Shamgar

2015-03-01

In vitro and ex vivo studies assessing the impact of stress hormones on immune competence commonly replace the natural milieu of leukocytes with an artificial medium, excluding plasma factors, hormones, and cytokines. Given prevalent inconsistencies between in vitro, ex vivo, and in vivo findings, we studied whether such procedures could yield misleading outcomes regarding the impact of stress hormones on NK cell cytotoxicity (NKCC), using fresh human whole blood samples. We found that in the presence of plasma 10-30-fold higher concentrations of cortisol, epinephrine, and prostaglandin-E2 (PGE2) were required to reach suppression levels evident in the context of artificial medium. Importantly, whereas the NK suppressive effects of PGE2 occurred immediately and remained stable upon prolonged exposure, the suppressive effects of cortisol slowly increased over time. Last, to simulate the exclusion of stress factors in the ex vivo approach, we subjected whole blood to stress hormones (as occurs in vivo), and abruptly removed them. We found that the effects of epinephrine and PGE2 quickly disappeared, while the effects of cortisol persisted. Overall, these findings demonstrate the potential misleading nature of in vitro and ex vivo procedures, and specifically suggest that (i) the common in vitro findings of profound suppression of NKCC by stress hormones are overestimation of their direct effects expected in vivo; and (ii) the common ex vivo approach cannot reflect the direct in vivo suppressive effects of epinephrine and PGE2 on NKCC, while inflating the effects of glucocorticoids. Some of these fallacies may be circumvented by using non-delayed whole blood NKCC assays in humans. Copyright © 2014 Elsevier Inc. All rights reserved.

Self-reported allergic reactions to peanut on commercial airliners.

PubMed

Sicherer, S H; Furlong, T J; DeSimone, J; Sampson, H A

1999-07-01

Allergic reactions to food occurring on commercial airlines have not been systematically characterized. We sought to describe the clinical characteristics of allergic reactions to peanuts on airplanes. Participants in the National Registry of Peanut and Tree Nut Allergy who indicated an allergic reaction while on a commercial airliner were interviewed by telephone. Sixty-two of 3704 National Registry of Peanut and Tree Nut Allergy participants indicated a reaction on an airplane; 42 of 48 patients or parental surrogates contacted confirmed the reaction began on the airplane (median age of affected subject, 2 years; range, 6 months to 50 years). Of these, 35 reacted to peanuts (4 were uncertain of exposure) and 7 to tree nuts, although 3 of these 7 reacted to substances that may have also contained peanut. Exposures occurred by ingestion (20 subjects), skin contact (8 subjects), and inhalation (14 subjects). Reactions generally occurred within 10 minutes of exposure (32 of 42 subjects), and reaction severity correlated with exposure route (ingestion > inhalation > skin). The causal food was generally served by the airline (37 of 42 subjects). Medications were given in flight to 19 patients (epinephrine to 5) and to an additional 14 at landing/gate return (including epinephrine to 1 and intravenous medication to 2), totaling 79% treated. Flight crews were notified in 33% of reactions. During inhalation reactions as a result of peanut allergy, greater than 25 passengers were estimated to be eating peanuts at the time of the reaction. Initial symptoms generally involved the upper airway, with progression to the skin or further lower respiratory reactions (no gastrointestinal symptoms). Allergic reactions to peanuts and tree nuts caused by accidental ingestion, skin contact, or inhalation occur during commercial flights, but airline personnel are usually not notified. Reactions can be severe, requiring medications, including epinephrine.

International study of risk-mitigating factors and in-flight allergic reactions to peanut and tree nut.

PubMed

Greenhawt, Matthew; MacGillivray, Fiona; Batty, Geraldine; Said, Maria; Weiss, Christopher

2013-03-01

Three studies have analyzed in-flight peanut/tree nut reactions, although the studies were conducted exclusively among Americans. We studied the international in-flight experience and determined the efficacy of certain risk-mitigation strategies. A 47-question on-line survey was distributed through the websites and social media outlets of the member organizations of the Food Allergy & Anaphylaxis Alliance. Both persons reporting an in-flight reaction and nonreactors were surveyed to assess details of air travel preparation and any reported reaction. Data were analyzed to determine the association among flying behaviors, reported reactions, and nationality. We found that 349 reactions were reported among 3273 respondents from 11 countries; 13.3% received epinephrine as treatment. Flight crews were notified about 50.1% of reactions. Sixty-nine percent of all respondents reported making a preflight accommodation request, although just 55% of reactors did so compared with 71.6% of nonreactors (P < .001). Adjusted odds of epinephrine use were increased with reported gastrointestinal or cardiovascular symptoms or with notifying the crew. Passengers who requested any accommodation, requested a peanut/tree nut-free meal, wiped their tray table, avoided airline pillows or blankets, requested a buffer zone, requested other passengers not consume peanut/tree nut-containing products, or reported not consuming airline-provided food had significantly lower adjusted odds of reporting a reaction. In-flight peanut and tree nut reactions occur internationally. Epinephrine was sparsely used to treat reactions. We identified 8 risk-mitigating behaviors associated with lower odds of a reported reaction. Future study is necessary to further validate the effectiveness of these passenger-initiated risk-mitigating behaviors. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Stressed lungs: unveiling the role of circulating stress hormones in ozone-induced lung injury and inflammation

EPA Science Inventory

Our recent work demonstrated that circulating stress hormones, epinephrine and corticosterone/cortisol, are involved in mediating ozone pulmonary effects through the activation of hypothalamus-pituitary-adrenal (HPA) axis. Adrenalectomy in Wistar Kyoto (WKY) rats diminished circu...

Anaphylaxis: a history with emphasis on food allergy

PubMed Central

Boden, Stephen R.; Burks, A. Wesley

2011-01-01

Summary In the century since Paul Portier and Charles Richet described their landmark findings of severe fatal reactions in dogs re-exposed to venom after vaccination with sea anemone venom, treatment for anaphylaxis continues to evolve. The incidence of anaphylaxis continues to be difficult to measure. Underreporting due to patients not seeking medical care as well as failure to identify anaphylaxis affects our understanding of the magnitude of the disease. Treatment with intramuscular epinephrine continues to be the recommended first line therapy although studies indicate that education of both the patients and the medical community is needed. Adverse food reactions continue to be the leading cause of anaphylaxis presenting for emergency care. Current therapy for food-induced anaphylaxis is built on the foundation of strict dietary avoidance, rapid access to injectable epinephrine, and education to recognize signs and symptoms of anaphylaxis. Investigation into therapy with oral and sublingual immunotherapy as well as other modalities holds hope for improved treatment of food-induced anaphylaxis. PMID:21682750

Calcium in the control of renin release.

PubMed

Park, C S; Malvin, R L

1978-07-01

The effect of Ca concentrations in the incubation medium and of estimated intracellular Ca concentrations on renin release was examined with use of pig renal cortical slices. In addition, the Ca requirement for the epinephrine stimulatory effect and for the ouabain inhibitory action on renin release was also tested. In mediums containing 5.9 mM K, variations in Ca concentration had no effect on renin release. In contrast, when the K concentration was 59 mM, a significant inhibition of renin release was attained with all concentrations of calcium. The inhibition of renin release in high K mediums by Ca was attributed to an increase in the intracellular Ca concentration. In addition, both the stimulatory effect of epinephrine and the inhibitory effect of ouabain on renin release required Ca in the medium. These results support the hypothesis that the control of renin secretion is mediated, in part, by changes in the intracellular concentration of Ca, most likely in the juxtaglomerular cells.

Platelet aggregation inhibitors from Philippine marine invertebrate samples screened in a new microplate assay.

PubMed

Pimentel, Sheila Marie V; Bojo, Zenaida P; Roberto, Amy V D; Lazaro, Jose Enrico H; Mangalindan, Gina C; Florentino, Leila M; Lim-Navarro, Pilar; Tasdemir, Deniz; Ireland, Chris M; Concepcion, Gisela P

2003-01-01

A new microplate assay for Ca(2+)-induced platelet aggregation as detected by Giemsa dye was used to screen marine invertebrate samples from the Philippines for inhibitors of human platelet aggregation. Out of 261 crude methanol extracts of marine sponges and tunicates, 25 inhibited aggregation at 2 mg/ml. Inhibition of agonist-induced aggregation in an aggregometer was used to confirm results of the microplate assay and to determine the specific mode of inhibition of 2 samples. The marine sponge Xestospongia sp. yielded a xestospongin/araguspongine-type molecule that inhibited collagen-induced aggregation by 87% at 2 micro g/ml, and epinephrine-induced aggregation by 78% at 20 micro g/ml, while the marine sponge Aplysina sp. yielded 5,6-dibromotryptamine, which inhibited epinephrine-induced aggregation by 51% at 20 micro g/ml. In this study we have found that the microplate assay is a simple, inexpensive, yet useful preliminary tool to qualitatively screen a large number of marine samples for antiplatelet aggregation activity.

Ficts and facts of epinephrine and norepinephrine stability in injectable solutions.

PubMed

Hoellein, Ludwig; Holzgrabe, Ulrike

2012-09-15

Epinephrine (EPI) and norepinephrine (NE) play an important role in emergency medicine and acute treatment of hypotension and shocks in the intensive care unit. Injectable solutions can either be provided as proprietary medicinal products or as individually prepared dilutions. Due to the chemical structure of EPI and NE, the stability of the corresponding solutions is limited. Thus, most manufacturers of EPI and NE injectable solutions use sulfites and nitrogen for stabilization, Nevertheless, storage conditions such as temperature and light have to be considered, but are often neglected in the daily hospital routine. In addition, hospital pharmacies prepare EPI and NE solutions and dilute commercially available solutions for individual therapy, especially on ICUs. Since the influence of dilution and the presence of excipients and other preservatives are not systematically explored, we collected published data and investigations on stability on the potency of EPI and NE injectable solutions in order to deduce storage recommendations for diluted EPI and NE solutions of different concentration. Copyright © 2012 Elsevier B.V. All rights reserved.

Development of a Tool to Measure Youths' Food Allergy Management Facilitators and Barriers.

PubMed

Herbert, Linda Jones; Lin, Adora; Matsui, Elizabeth; Wood, Robert A; Sharma, Hemant

2016-04-01

This study's aims are to identify factors related to allergen avoidance and epinephrine carriage among youth with food allergy, develop a tool to measure food allergy management facilitators and barriers, and investigate its initial reliability and validity.  The Food Allergy Management Perceptions Questionnaire (FAMPQ) was developed based on focus groups with 19 adolescents and young adults with food allergy. Additional youth with food allergy (N = 92; ages: 13-21 years) completed food allergy clinical history and management questionnaires and the FAMPQ.  Internal reliability estimates for the FAMPQ Facilitators and Barriers subscales were acceptable to good. Youth who were adherent to allergen avoidance and epinephrine carriage had higher Facilitator scores. Poor adherence was more likely among youth with higher Barrier scores.  Initial FAMPQ reliability and validity is promising. Additional research is needed to develop FAMPQ clinical guidelines. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Ultrasensitive chemosensory responses by a protozoan to epinephrine and other neurochemicals.

PubMed

Hauser, D C; Levandowsky, M; Glassgold, J M

1975-10-17

A behavioral assay was developed based on differential tendency of a protozoan to attach to an agar gel containing the test substance. The heterotrophic marine dinoflagellate Crypthecodinium (Gyrodinium) cohnii responded negatively (less tendency to attach) to epinephrine at concentrations above 5 X 10(-15)M and to norepinephrine at concentrations above 5 X 10(-9)M. Response to choline as choline H2 citrate, choline bitartrate, and choline chloride was negative above 10(-7)M, but response to the choline analog carbachol was positve (greater tendency to attach) in the range 5 X 10(-6) to 5 X 10(-4)M. Other responses to neurochemicals at comparable concentrations were: dopa, betaine, and glycine--positive; L-glutamic acid, tryptophan, putrescine, and taurine--negative. Serotonin was inert, responses to tyrosine and gamma-aminobutyric acid were variable, and phenylalanine (6 X 10(-3)M) and 5-hydroxytryptophan (5 X 10(-4)M) were negative only at the highest concentrations tested.

The antagonistic effects of atipamezole and yohimbine on stress-related neurohormonal and metabolic responses induced by medetomidine in dogs

PubMed Central

Ambrisko, T. D.; Hikasa, Y.

2003-01-01

This study aimed to compare the antagonistic effects of atipamezole (40, 120, and 320 μg/kg, IM), yohimbine (110 μg/kg, IM), and saline on neurohormonal and metabolic responses induced by medetomidine (20 μg/kg, IM). Five beagle dogs were used in each of the 5 experimental groups in randomized order. Blood samples were taken for 6 h. Medetomidine significantly decreased norepinephrine, epinephrine, insulin, and nonesterified fatty acid levels, and increased plasma glucose levels. Both atipamezole and yohimbine antagonized these effects. The reversal effect of atipamezole was dose-dependency, except on epinephrine. Yohimbine caused prolonged increases in plasma norepinephrine and insulin levels compared to atipamezole, possibly because of its longer half-life elimination. Only yohimbine increased the cortisol levels. Neither glucagon nor lactate levels changed significantly. Based on these findings, when medetomidine-induced sedation is antagonized in dogs, we recommend using atipamezole IM, from 2- to 6-fold the dose of medetomidine, unless otherwise indicated. PMID:12528832

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-.

PubMed

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang; Lim, Hyun Kyoung

2013-12-01

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage.

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-

PubMed Central

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang

2013-01-01

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage. PMID:24427464

Fasting induces a form of autonomic synaptic plasticity that prevents hypoglycemia

PubMed Central

Wang, Manqi; Wang, Qian; Whim, Matthew D.

2016-01-01

During fasting, activation of the counter-regulatory response (CRR) prevents hypoglycemia. A major effector arm is the autonomic nervous system that controls epinephrine release from adrenal chromaffin cells and, consequently, hepatic glucose production. However, whether modulation of autonomic function determines the relative strength of the CRR, and thus the ability to withstand food deprivation and maintain euglycemia, is not known. Here we show that fasting leads to altered transmission at the preganglionic → chromaffin cell synapse. The dominant effect is a presynaptic, long-lasting increase in synaptic strength. Using genetic and pharmacological approaches we show this plasticity requires neuropeptide Y, an adrenal cotransmitter and the activation of adrenal Y5 receptors. Loss of neuropeptide Y prevents a fasting-induced increase in epinephrine release and results in hypoglycemia in vivo. These findings connect plasticity within the sympathetic nervous system to a physiological output and indicate the strength of the final synapse in this descending pathway plays a decisive role in maintaining euglycemia. PMID:27092009

Estrogen supplementation attenuates glucocorticoid and catecholamine responses to mental stress in perimenopausal women.

PubMed

Komesaroff, P A; Esler, M D; Sudhir, K

1999-02-01

Estrogens are reported to provide protection against the development of cardiovascular disease in women, but the mechanisms underlying these effects are not well defined. We hypothesized that estrogen might affect the hormonal responses to stress. We therefore studied cortisol, ACTH, epinephrine, norepinephrine, and norepinephrine spillover and hemodynamic responses to a 10-min mental arithmetic test in 12 perimenopausal women randomized to 8 weeks of estrogen supplementation (estradiol valerate, 2 mg daily; n = 7) or placebo (n = 5). Total body and forearm norepinephrine spillover were measured by radiotracer methodology. After supplementation with estradiol, the increases in both systolic and diastolic blood pressure in response to mental stress were reduced, and cortisol, ACTH, plasma epinephrine and norepinephrine, and total body norepinephrine spillover responses to stress were significantly attenuated (P < 0.05 in each case). Forearm norepinephrine spillover was unchanged by estrogen, and there was no change in any of the responses after placebo. We conclude that estrogen supplementation in perimenopausal women attenuates blood pressure, glucocorticoid, and catecholamine responses to psychological stress.

A comparison of two methods of infiltration in breast reduction surgery.

PubMed

Armour, A D; Rotenberg, B W; Brown, M H

2001-08-01

The superwet technique has been shown in previous studies to dramatically reduce blood loss in breast reduction surgery, compared with standard infiltration. A retrospective chart review of 303 consecutive patients undergoing bilateral breast reduction surgery was undertaken to demonstrate additional differences in complication rate, operative time, or sponge use in the operating room. In this series, 132 consecutive patients received standard infiltration along incision lines (25 cc per breast of 1:100,000 epinephrine), and 171 patients received superwet infiltration with 240 cc per breast of 1:1,000,000 epinephrine. The average operative time was significantly reduced in the superwet group, from 78.5 minutes to 70.7 minutes (p < 0.01 level). The average number of sponges used intraoperatively was also decreased significantly (p < 0.01), from 26 to 20 sponges. Complication rates were equally low in both groups, demonstrating the safety of the superwet technique. In addition to limiting blood loss, the superwet infiltration effectively reduces operative time and sponge use without increasing complications in breast reduction surgery.

Salmon caviar-induced anaphylactic shock.

PubMed

Flais, Michael J; Kim, Susan S; Harris, Kathleen E; Greenberger, Paul A

2004-01-01

Foods, particularly shellfish and nuts, are commonly implicated as causes of anaphylaxis. Salmon caviar, to our knowledge, is an exceedingly rare cause of anaphylactic shock. This study describes a patient who experienced anaphylactic shock on her initial ingestion of caviar. Skin testing and inhibition assays using the enzyme-linked immunosorbent assay were performed. On the percutaneous test, the patient had a 7 x 9 mm/15 x 55 mm wheal/ erythema reaction to caviar liquid. Caviar liquid caused 68, 73, and 73% inhibition of immunoglobulin E (IgE) binding at concentrations of 0.01, 0.1, and 1.0 mg/mL in an enzyme-linked immunosorbent assay, respectively. There was no evidence for IgE antibodies that could be demonstrated to bind to the caviar eggs. Despite using both metoprolol and lisinopril, the patient responded promptly to subcutaneous epinephrine. This report indicates that an IgE-mediated response occurred after caviar ingestion. Although she experienced anaphylactic shock, the patient recovered quickly after epinephrine administration despite routine use of a 3-adrenergic blocker and angiotensin-converting enzyme inhibitor.

Experimental model of inappropriate sinus tachycardia: initiation and ablation.

PubMed

Scherlag, Benjamin J; Yamanashi, William S; Amin, Rohit; Lazzara, Ralph; Jackman, Warren M

2005-06-01

The purpose of the present study was to develop an experimental model of inappropriate sinus tachycardia (IST) by injecting a catecholamine into a fat pad containing autonomic ganglia (AG) innervating the sinus node (SN). Initial protocols in 3 groups of pentobarbital anesthetized dogs consisted of (1) slowing the heart rate (HR) by electrical stimulation of AG in the fat pad; (2) the effect of intravenous injection of epinephrine (0.1-0.3 mg) on the HR and systolic blood pressure (BP); (3) the response of SN rate to intravenously injected isoproterenol (1 microgm/kg). These studies established a reference for the response to epinephrine injection (mean dose 0.2 +/- 0.9 mg, n = 14) into the fat pad at the base of the right superior pulmonary vein (RSPV). ECG leads, right atrial and His bundle electrograms, BP and core body temperature were continuously monitored. Epinephrine, injected into the fat pad, caused a significant increase in heart rate (HR, average: 211 +/- 11/min, p < 0.05 compared to control) but little change in systolic BP, 149 +/- 10 mmHg, p = NS (Group I, N = 8). The tachycardia lasted >30 minutes. Ice mapping and P wave morphology showed the tachycardia origin in the SN in 6/8 and in the crista terminalis (CT) in 2. Injection of 0.4 cc of formaldehyde into the FP restored HR (159 +/- 16) toward baseline (154 +/- 18). In Group II (N = 6), the same regimen induced a significant increase in both HR and systolic BP (194 +/- 17/min and 230 +/- 24 mmHg, respectively) compared to control values (143 +/- 23/min, 162 +/- 24 mmHg) which lasted for > 30 minutes. Ice mapping and P wave morphology showed that the pacemaker was in the SN (1), overlying the CT (2), or atrioventricular junction (2). Formaldehyde (0.4 cc) injected into the FP restored both HR and systolic BP toward baseline values (148 +/- 29/min and 152 +/- 24 mmHg, p = NS) and prevented, slowing of the HR by electrical stimulation of the AG; moreover, the same dose of epinephrine injected intravenously increased HR and SBP but only for 2-5 minutes; Isoproterenol (1 microg/kg) injected intravenously induced essentially the same increase in sinus rate after AG ablation as in the control state (194 +/- 15/min vs 193 +/- 23/min, p = NS). Experimental IST is mainly localized in the SN or CT. Ablation of the AG terminates IST without impairing the SN response to an adrenergic challenge.

Barriers to the Administration of Epinephrine in Schools

ERIC Educational Resources Information Center

Hogue, Susan L.; Muniz, Rafael; Herrem, Christopher; Silvia, Suyapa; White, Martha V.

2018-01-01

Background: Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food-induced severe allergic reactions continues to increase. Methods: A cross-sectional, web-based survey was conducted regarding anaphylactic events that occurred during the 2014-2015 school year. Eligible schools were enrolled…

Vaccination of High-Risk Breast Cancer Patients with Carbohydrate Mimicking Peptides

DTIC Science & Technology

2009-05-01

medications such as Benadryl, epinephrine, high dose steroids, etc. also on site The Medical Monitor will review all side effects on a regular basis......for biological and/or pathological significance. Results: One animal in the high - dose Necropsy #3 group was excluded from analysis because it

Inhaled Ozone (O3)-Induces Changes in Serum Metabolomic and Liver Transcriptomic Profiles in Rats

EPA Science Inventory

Air pollution has been linked to increased incidence of diabetes. Recently, we showed that ozone (03) induces glucose intolerance, and increases serum leptin and epinephrine in Brown Norway rats. In this study, we hypothesized that 03 exposure will cause systemic changes in metab...

School Access to Emergency Epinephrine Act

THOMAS, 113th Congress

Sen. Durbin, Richard J. [D-IL

2013-09-12

Senate - 09/12/2013 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Notes: For further action, see H.R.2094, which became Public Law 113-48 on 11/13/2013. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

A Burn Intensive Care Unit Nurse’s Perspective

DTIC Science & Technology

2012-01-01

graft, is a continuous layer of donor skin that is harvested from the donor site and secured to the patient with staples, sutures, or adhesive strips...sterile burn sponges soaked in a solution of 10 cc epinephrine 1:100,000 U in 1 L sterile normal saline irrigation) then compressed with an elastic bandage

Impact of Food Allergies on School Nursing Practice

ERIC Educational Resources Information Center

Weiss, Christopher; Munoz-Furlong, Anne; Furlong, Terence J.; Arbit, Julie

2004-01-01

Food allergies affect 11 million Americans, including 6-8% of children. The rate of peanut allergies in children doubled from 1997 to 2002. There is no cure; therefore, strict avoidance of the allergen is the only way to avoid a reaction. Fatalities are associated with delays in or lack of epinephrine administration. Severe reactions, called…

Autonomic and Neuroendocrine Responses to a Psychosocial Stressor in Adults with Autistic Spectrum

ERIC Educational Resources Information Center

Jansen, Lucres M. C.; Gispen-de Wied, Christine C.; Wiegant, Victor M.; Westenberg, Herman G. M.; Lahuis, Bertine E.; van Engeland, Herman

2006-01-01

Objective of the study was to replicate in adults our previous findings of decreased heart rate and normal endocrine responses to stress in autistic children and to elucidate the discrepancy between autonomic and endocrine stress responses by including epinephrine, norepinephrine, oxytocin and vasopressin measurements. Ten autistic spectrum…

Serum Metabolomic Profiling and Liver Transcriptomic Analysis Provide Mechanistic Evidence of Ozone (O3)- Induced Systemic Metabolic Impairment

EPA Science Inventory

Recently, air pollution has been linked to insulin resistance and obesity but the mechanisms remain to be elucidated. We have recently shown that acute O3 exposure induces glucose intolerance, hyperglycemia and increases in leptin and epinephrine in rats. Here, we hypothesized th...

21 CFR 500.65 - Epinephrine injection 1:1,000 in 10-milliliter containers for emergency treatment of...

Code of Federal Regulations, 2013 CFR

2013-04-01

... containers for emergency treatment of anaphylactoid shock in cattle, horses, sheep, and swine. 500.65 Section... cattle, horses, sheep, and swine. (a) Anaphylactoid reactions in cattle, horses, sheep, and swine occur... treating anaphylactoid shock. Usual Dosage: Cattle, horses, sheep, and swine—1 cubic centimeter per 100...

21 CFR 500.65 - Epinephrine injection 1:1,000 in 10-milliliter containers for emergency treatment of...

Code of Federal Regulations, 2014 CFR

2014-04-01

... containers for emergency treatment of anaphylactoid shock in cattle, horses, sheep, and swine. 500.65 Section... cattle, horses, sheep, and swine. (a) Anaphylactoid reactions in cattle, horses, sheep, and swine occur... treating anaphylactoid shock. Usual Dosage: Cattle, horses, sheep, and swine—1 cubic centimeter per 100...

21 CFR 500.65 - Epinephrine injection 1:1,000 in 10-milliliter containers for emergency treatment of...

Code of Federal Regulations, 2012 CFR

2012-04-01

... containers for emergency treatment of anaphylactoid shock in cattle, horses, sheep, and swine. 500.65 Section... cattle, horses, sheep, and swine. (a) Anaphylactoid reactions in cattle, horses, sheep, and swine occur... treating anaphylactoid shock. Usual Dosage: Cattle, horses, sheep, and swine—1 cubic centimeter per 100...

Effects of acute exposure to WIFI signals (2.45GHz) on heart variability and blood pressure in Albinos rabbit.

PubMed

Saili, Linda; Hanini, Amel; Smirani, Chiraz; Azzouz, Ines; Azzouz, Amina; Sakly, Mohsen; Abdelmelek, Hafedh; Bouslama, Zihad

2015-09-01

Electrocardiogram and arterial pressure measurements were studied under acute exposures to WIFI (2.45GHz) during one hour in adult male rabbits. Antennas of WIFI were placed at 25cm at the right side near the heart. Acute exposure of rabbits to WIFI increased heart frequency (+22%) and arterial blood pressure (+14%). Moreover, analysis of ECG revealed that WIFI induced a combined increase of PR and QT intervals. By contrast, the same exposure failed to alter maximum amplitude and P waves. After intravenously injection of dopamine (0.50ml/kg) and epinephrine (0.50ml/kg) under acute exposure to RF we found that, WIFI alter catecholamines (dopamine, epinephrine) action on heart variability and blood pressure compared to control. These results suggest for the first time, as far as we know, that exposure to WIFI affect heart rhythm, blood pressure, and catecholamines efficacy on cardiovascular system; indicating that radiofrequency can act directly and/or indirectly on cardiovascular system. Copyright © 2015 Elsevier B.V. All rights reserved.

Molecular cloning and functional expression of the guinea pig alpha(1a)-adrenoceptor.

PubMed

González-Espinosa, C; Romero-Avila, M T; Mora-Rodríguez, D M; González-Espinosa, D; García-Sáinz, J A

2001-08-31

In the present paper, the cloning and expression of the guinea pig alpha(1A)-adrenoceptor is presented. The nucleotide sequence had an open reading frame of 1401 bp that encoded a 466 amino-acid protein with an estimated molecular mass of approximately 51.5 kDa. When the clone was expressed in Cos-1 cells, specific high-affinity binding of [(3)H]prazosin and [(3)H]tamsulosin was observed. Chloroethylclonidine treatment of membranes slightly decreased the total binding with both radioligands. Binding competition experiments using [(3)H]tamsulosin showed the following potency order: (a) for agonists: oxymetazoline >epinephrine>norepinephrine>methoxamine, and (b) for antagonists: prazosin> or 5-methyl-urapidil=benoxathian>phentolamine>BMY 7378 (8-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-8-azaspiro[4,5]decane-7,9-dione). Photoaffinity labeling using [(125)I-aryl]azido-prazosin revealed a major broad band with a molecular mass between 70 and 80 kDa. The receptor was functional, as evidenced by an epinephrine-increased production of [(3)H]inositol phosphates that was blocked by prazosin.

Catecholamine plasma levels, IFN-γ serum levels and antibodies production induced by rabies vaccine in dogs selected for their paw preference.

PubMed

Siniscalchi, Marcello; Cirone, Francesco; Guaricci, Antonio Ciro; Quaranta, Angelo

2014-01-01

To explore the possible role of the sympathetic nervous activity in the asymmetrical crosstalk between the brain and immune system, catecholamine (E, NE) plasma levels, Interferon-γ (IFN-γ) serum levels and production of antibodies induced by rabies vaccine in dogs selected for their paw preference were measured. The results showed that the direction of behavioural lateralization influenced both epinephrine levels and immune response in dogs. A different kinetic of epinephrine levels after immunization was observed in left-pawed dogs compared to both right-pawed and ambidextrous dogs. The titers of antirabies antibodies were lower in left-pawed dogs than in right-pawed and ambidextrous dogs. Similarly, the IFN-γ serum levels were lower in left-pawed dogs than in the other two groups. Taken together, these findings showed that the left-pawed group appeared to be consistently the different group stressing the fundamental role played by the sympathetic nervous system as a mechanistic basis for the crosstalk between the brain and the immune system.

Perception of discomfort during injection and the need for supplemental anesthesia in the intraosseous technique using 4% articaine.

PubMed

Martínez Martínez, Adel; Lujan Pardo, María Del Pilar; Harris Ricardo, Jonathan

2016-12-01

The authors conducted an experimental study to determine patient perception of discomfort during injection and the need for supplemental anesthesia using the intraosseous technique with 4% articaine with 1:100,000 epinephrine in patients with symptomatic pulpitis in mandibular molars. At different clinical sessions, researchers used 4% articaine with 1:100,000 epinephrine to apply intraosseous injection (Group 1) or inferior alveolar nerve block (Group 2). Each technique was applied in 35 patients. In each group, the need for additional anesthesia was determined and patient discomfort during injection was assessed with a Visual Analogue Scale (VAS) test. In the intraosseous group, no supplemental technique was needed in 22 patients (62.85 %), and results were similar for the inferior alveolar technique (n: 23 65.71%). The intraosseous technique proved to be more comfortable than the mandibular technique (18 patients - 25.7%). This study found that the use of intraosseous technique with 4% articaine shows promising results regarding patient comfort and reducing the need for additional anesthesia. Sociedad Argentina de Investigación Odontológica.

Anaphylaxis: a history with emphasis on food allergy.

PubMed

Boden, Stephen R; Wesley Burks, A

2011-07-01

In the century since Paul Portier and Charles Richet described their landmark findings of severe fatal reactions in dogs re-exposed to venom after vaccination with sea anemone venom, treatment for anaphylaxis continues to evolve. The incidence of anaphylaxis continues to be difficult to measure. Underreporting due to patients not seeking medical care as well as failure to identify anaphylaxis affects our understanding of the magnitude of the disease. Treatment with intramuscular epinephrine continues to be the recommended first-line therapy, although studies indicate that education of both the patients and the medical community is needed. Adverse food reactions continue to be the leading cause of anaphylaxis presenting for emergency care. Current therapy for food-induced anaphylaxis is built on the foundation of strict dietary avoidance, rapid access to injectable epinephrine, and education to recognize signs and symptoms of anaphylaxis. Investigation into therapy with oral and sublingual immunotherapy as well as other modalities holds hope for improved treatment of food-induced anaphylaxis. Published 2011. This article is a US Government work and is in the public domain in the USA.

Effectiveness of Bupivacaine Liposome Injectable Suspension for Postoperative Pain Control in Total Knee Arthroplasty: A Prospective, Randomized, Double Blind, Controlled Study.

PubMed

DeClaire, Jeffrey H; Aiello, Paige M; Warritay, Olayinka K; Freeman, Dwight C

2017-09-01

We compared the effectiveness of liposomal bupivacaine to ropivacaine, each as part of multimodal pain management, in total knee arthroplasty (TKA) postoperative pain control. This prospective, double blind study randomized 96 TKA patients into a control group (periarticular injection of ropivacaine, ketorolac, morphine, and epinephrine in saline; 100cc) or an experimental group (periarticular injection of bupivacaine, ketorolac, morphine, and epinephrine in saline; 80cc plus 1.3% liposomal bupivacaine 20cc; total injection 100cc). The postoperative use of narcotics, visual analog pain scores, hours to ambulate 100 feet, and length of hospital stay were recorded. There was no significant difference between the two groups (control N = 49, experiment N = 47) in mean narcotic use per hour, total narcotic use during hospital stay, time to ambulate 100 feet, length of hospital stay, or visual analog score for pain postoperatively. There is no benefit in the use of liposomal bupivacaine compared with ropivacaine for postoperative pain control in TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

For your information. Management in the school setting: position statement.

PubMed

Zacharski, Susan; DeSisto, Marie; Pontius, Deborah; Sheets, Jodi; Richesin, Cynthia

2013-09-01

It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse) is the leader in a comprehensive management approach that includes planning and coordination of care, educating staff, providing a safe environment, and ensuring prompt emergency response should exposure to a life-threatening allergen occur. Furthermore, NASN supports, in states where laws and regulations allow, the maintenance of stock nonpatient-specific epinephrine and physician-standing orders for school nurses to administer epinephrine in life-threatening situations in the school setting. School districts must have a clear, concise, all-inclusive policy in place to address the management of allergies in the school setting that should be reviewed annually (National School Boards Association [NSBA], 2012). This policy shall be consistent with federal and state laws, nursing practice standards, and established safe practices in accordance with evidence-based information and include development of a developmentally appropriate Individualized Healthcare Plan (IHP) and Emergency Care Plan (ECP).

Synthesis, characterization and electrochemical properties of 5-aza[5]helicene-CH2O-CO-MWCNTs nanocomposite

NASA Astrophysics Data System (ADS)

Fontana, F.; Melone, F.; Iannazzo, D.; Leonardi, S. G.; Neri, G.

2017-03-01

In this study, we report the preparation of a novel nanocomposite, 5-aza[5]helicene-CH2O-CO-MWCNTs, obtained by grafting the 5-aza[5]helicene moiety on the surface of multi-walled carbon nanotubes (MWCNTs). Thermogravimetry (TGA), Fourier transform-infrared spectroscopy (FTIR), ultraviolet (UV), and photoluminescence (PL) measurements provided evidence that the organic moiety is covalently grafted to the MWCNTs. The 5-aza[5]helicene-CH2O-CO-MWCNTs nanocomposite was utilized to fabricate modified commercial screen-printed carbon electrodes. Its electrochemical behavior was studied in neutral buffer solution in the presence of ferricyanide and hydroquinone (HQ). Finally, the electrochemical sensing of epinephrine in the presence of ascorbic acid by using the linear sweep voltammetry (LSV) technique was investigated. Results have demonstrated the enhanced electrocatalytic activity and excellent ability of the 5-aza[5]helicene-CH2O-CO-MWCNTs-modified electrode in the separation between the anodic peaks of epinephrine (EP) and ascorbic acid (AA), even in the presence of a high amount of AA, with a detection limit (S/N = 3) of 5 μmol l-1.

Ability of higenamine and related compounds to enhance glucose uptake in L6 cells.

PubMed

Kato, Eisuke; Kimura, Shunsuke; Kawabata, Jun

2017-12-15

β2-Adrenergic receptor (β2AR) agonists are employed as bronchodilators to treat pulmonary disorders, but are attracting attention for their modulation of glucose handling and energy expenditure. Higenamine is a tetrahydroisoquinoline present in several plant species and has β2AR agonist activity, but the involvement of each functional groups in β2AR agonist activity and its effectiveness compared with endogenous catecholamines (dopamine, epinephrine, and norepinephrine) has rarely been studied. Glucose uptake of muscle cells are known to be induced through β2AR activation. Here, the ability to enhance glucose uptake of higenamine was compared with that of several methylated derivatives of higenamine or endogenous catecholamines. We found that: (i) the functional groups of higenamine except for the 4'-hydroxy group are required to enhance glucose uptake; (ii) higenamine shows a comparable ability to enhance glucose uptake with that of epinephrine and norepinephrine; (iii) the S-isomer shows a greater ability to enhance glucose uptake compared with that of the R-isomer. Copyright © 2017 Elsevier Ltd. All rights reserved.

Influence of infusion pump operation and flow rate on hemodynamic stability during epinephrine infusion.

PubMed

Klem, S A; Farrington, J M; Leff, R D

1993-08-01

To determine whether variations in the flow rate of epinephrine solutions administered via commonly available infusion pumps lead to significant variations in blood pressure (BP) in vivo. Prospective, randomized, crossover study with factorial design, using infusion pumps with four different operating mechanisms (pulsatile diaphragm, linear piston/syringe, cyclic piston-valve, and linear peristaltic) and three drug delivery rates (1, 5, and 10 mL/hr). Two healthy, mixed-breed dogs (12 to 16 kg). Dogs were made hypotensive with methohexital bolus and continuous infusion. BP was restored to normal with constant-dose epinephrine infusion via two pumps at each rate. Femoral mean arterial pressure (MAP) was recorded every 10 secs. Pump-flow continuity was quantitated in vitro using a digital gravimetric technique. Variations in MAP and flow continuity were expressed by the coefficient of variation; analysis of variance was used for comparisons. The mean coefficients of variations for MAP varied from 3.8 +/- 3.1% (linear piston/syringe) to 6.1 +/- 6.6% (linear peristaltic), and from 3.4 +/- 2.2% (10 mL/hr) to 7.9 +/- 6.6% (1 mL/hr). The coefficients of variation for in vitro flow continuity ranged from 9 +/- 8% (linear piston-syringe) to 250 +/- 162% (pulsatile diaphragm), and from 35 +/- 44% (10 mL/hr) to 138 +/- 196% (1 mL/hr). Both the type of pump and infusion rate significantly (p < .001) influenced variation in drug delivery rate. The 1 mL/hr infusion rate significantly (p < .01) influenced MAP variation. Cyclic fluctuations in MAP of < or = 30 mm Hg were observed using the pulsatile diaphragm pump at 1 mL/hr. Factors inherent in the operating mechanisms of infusion pumps may result in clinically important hemodynamic fluctuations when administering a concentrated short-acting vasoactive medication at slow infusion rates.

Comparison of the effects of sternal and tibial intraosseous administered resuscitative drugs on return of spontaneous circulation in a swine model of cardiac arrest.

PubMed

O'Sullivan, Mara; Martinez, Andre; Long, Audrey; Johnson, Michelle; Blouin, Dawn; Johnson, Arthur D; Burgert, James M

2016-01-01

Compare vasopressin, amiodarone, and epinephrine administration by sternal intraosseous (SIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine model of cardiac arrest. Prospective, randomized, between subjects, experimental design. Laboratory. Male Yorkshire-cross swine (N = 35), seven per group. Swine were randomized to SIO, TIO, IV, cardiopulmonary resuscitation (CPR) with defibrillation, or CPR-only groups. Ventricular fibrillation (VF) was induced under general anesthesia. Mechanical CPR began 2 minutes postarrest. Vasopressin (40 U) was administered to the SIO, TIO, and IV groups 4 minutes postarrest. Defibrillation was performed and amiodarone (300 mg) was administered 6 minutes postarrest. Defibrillation was repeated, and epinephrine (1 mg) was administered 10 minutes postarrest. Defibrillation was repeated every 2 minutes and epinephrine repeated every 4 minutes until return of spontaneous circulation (ROSC) or 26 postarrest minutes elapsed. Rate of ROSC, time to ROSC, and odds of ROSC. There were no significant differences in rate of ROSC between the SIO and TIO (p = 0.22) or IV groups (p = 1.0). Time to ROSC was five times less in the SIO group than the TIO group (p = 0.003) but not compared to IV (p = 0.125). Time to ROSC in the IV group was significantly less than the TIO group (p = 0.04). Odds of ROSC for the SIO group were five times higher compared to the TIO group but same as IV. Odds of ROSC in the IV group were higher than the TIO group. There was a statistically significant delay in the time to ROSC and a clinically significant difference in odds of ROSC when resuscitative drugs, including lipophilic amiodarone, were administered by the TIO route compared to the SIO and IV routes in a swine model of sudden cardiac arrest. Further investigations are warranted to isolate the mechanism behind these findings.

Role of cortisol in the pathogenesis of deficient counterregulation after antecedent hypoglycemia in normal humans.

PubMed Central

Davis, S N; Shavers, C; Costa, F; Mosqueda-Garcia, R

1996-01-01

The aim of this study was to determine the role of increased plasma cortisol levels in the pathogenesis of hypoglycemia-associated autonomic failure. Experiments were carried out on 16 lean, healthy, overnight fasted male subjects. One group (n = 8) underwent two separate, 2-d randomized experiments separated by at least 2 mo. On day 1 insulin was infused at a rate of 1.5 mU/kg per min and 2 h clamped hypoglycemia (53 +/- 2 mg/dl) or euglycemia (93 +/- 3 mg/dl) was obtained during morning and afternoon. The next morning subjects underwent a 2-h hyperinsulinemic (1.5 mU/kg per min) hypoglycemic (53 +/- 2 mg/dl) clamp study. In the other group (n = 8), day 1 consisted of morning and afternoon 2-h clamped hyperinsulinemic euglycemia with cortisol infused to stimulate levels of plasma cortisol occurring during clamped hypoglycemia (53 mg/dl). The next morning (day 2) subjects underwent a 2-h hyperinsulinemic hypoglycemic clamp identical to the first group. Despite equivalent day 2 plasma glucose and insulin levels, steady state epinephrine, norepinephrine, pancreatic polypeptide, glucagon, ACTH and muscle sympathetic nerve activity (MSNA) values were significantly (R < 0.01) blunted after day 1 cortisol infusion compared to antecedent euglycemia. Compared to day 1 cortisol, antecedent hypoglycemia produced similar blunted day 2 responses of epinephrine, norepinephrine, pancreatic polypeptide and MSNA compared to day 1 cortisol. Antecedent hypoglycemia, however, produced a more pronounced blunting of plasma glucagon, ACTH, and hepatic glucose production compared to day 1 cortisol. We conclude that in healthy overnight fasted men (a) antecedent physiologic increases of plasma cortisol can significantly blunt epinephrine, norepinephrine, glucagon, and MSNA responses to subsequent hypoglycemia and (b) these data suggest that increased plasma cortisol is the mechanism responsible for antecedent hypoglycemia causing hypoglycemia associated autonomic failure. PMID:8698859

Effects of carprofen, meloxicam and deracoxib on platelet function in dogs.

PubMed

Mullins, Kathleen B; Thomason, John M; Lunsford, Kari V; Pinchuk, Lesya M; Langston, Vernon C; Wills, Robert W; McLaughlin, Ronald M; Mackin, Andrew J

2012-03-01

To determine effects of anti-inflammatory doses of COX-2 selective NSAIDs carprofen, meloxicam, and deracoxib on platelet function in dogs and urine 11-dehydro-thromboxane B2. Randomized, blocked, crossover design with a 14-day washout period. Healthy intact female Walker Hounds aged 1-6 years and weighing 20.5-24.2 kg. Dogs were given NSAIDs for 7 days at recommended doses: carprofen (2.2 mg kg(-1), PO, every 12 hours), carprofen (4.4 mg kg(-1), PO, every 24 hours), meloxicam (0.2 mg kg(-1), PO, on the 1st day then 0.1 mg kg(-1), PO, every 24 hours), and deracoxib (2 mg kg(-1), PO, every 24 hours). Collagen/epinephrine and collagen/ADP PFA-100 cartridges were used to evaluate platelet function before and during and every other day after administration of each drug. Urine 11-dehydro-thromboxane B(2) was also measured before and during administration of each drug. All NSAIDs significantly prolonged PFA-100 closure times when measured with collagen/epinephrine cartridges, but not with collagen/ADP cartridges. The average duration from drug cessation until return of closure times (collagen/epinephrine cartridges) to baseline values was 11.6, 10.6, 11 and 10.6 days for carprofen (2.2 mg kg(-1) every 12 hours), carprofen (4.4 mg kg(-1) every 24 hours), meloxicam and deracoxib, respectively. Oral administration of some COX-2 selective NSAIDs causes detectable alterations in platelet function in dogs. As in humans, PFA-100 collagen/ADP cartridges do not reliably detect COX-mediated platelet dysfunction in dogs. Individual assessment of platelet function is advised when administering these drugs prior to surgery, particularly in the presence of other risk factors for bleeding. © 2011 The Authors. Veterinary Anaesthesia and Analgesia. © 2011 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

Adiponectin and catecholamine concentrations during acute exercise in children with type 1 diabetes.

PubMed

2008-06-01

Adiponectin, an adipokine secreted by the adipocyte, is inversely related to adiposity and directly related to insulin sensitivity. In type 1 diabetes mellitus (T1DM), however, data thus far are contradictory. We investigated the relationship between adiponectin and exercise inT1DM. Forty-nine children (14.5 +/- 2.0 yr, range 8-17 yr) with T1DM on an insulin pump were studied during two 75-min exercise sessions with and without continuation of the basal rate within 4 wk. Adiponectin and epinephrine concentrations were measured before and during exercise. Mean preexercise adiponectin concentration was 11.2 +/- 4.7 mg/L (range 2.7-23.0 mg/L) with a mean absolute difference of 1.7 mg/L between the 2 d. Adiponectin concentrations did not change meaningfully during exercise (mean change: -0.1 +/- 1.2 mg/L; p = 0.17). Adiponectin correlated inversely with body mass index percentile (p = 0.02) but not with age, gender, duration of diabetes, hemoglobin A1c, or preexercise glucose. However, those with higher baseline adiponectin concentrations were less likely to become hypoglycemic during exercise, 36% becoming hypoglycemic when baseline adiponectin concentration was <10 mg/L, 42% when 10 to <15 mg/L, and 15% when > or =15 mg/L (p = 0.02). Baseline epinephrine concentrations were not associated with adiponectin, and in those whose nadir glucose was < or =100 mg/dL, there was no correlation between epinephrine response and adiponectin (p = 0.16). Adiponectin concentrations are stable from day to day, are not affected by acute exercise or metabolic control, and vary inversely with adiposity. Higher adiponectin concentration appears to be associated with a decrease in hypoglycemia risk during exercise. Further studies are needed to examine whether adiponectin protects against exercise-induced hypoglycemia by directly enhancing the oxidation of alternate fuels.

Local administration of mangiferin prevents experimental inflammatory mechanical hyperalgesia through CINC-1/epinephrine/PKA pathway and TNF-α inhibition.

PubMed

Rocha, Lilian Wünsch; Bonet, Ivan José Magayewski; Tambeli, Claudia Herrera; de-Faria, Felipe Meira; Parada, Carlos Amilcar

2018-07-05

Steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to control inflammatory pain, but there is a risk of gastrointestinal bleeding and increased heart failure risk. The search for new drugs remains ongoing, and natural products are a source for potential new compounds. Mangiferin, a natural xanthone C-glucoside, has demonstrated biological activity, including anti-inflammatory and analgesic properties, but it's mechanisms are poorly understood. In this study, we investigated the mechanisms underlying the anti-inflammatory and analgesic effects of local administration of mangiferin. We employed an electronic von Frey apparatus to evaluate mechanical hyperalgesia induced by carrageenan in rats. Mangiferin (150-1200 µg/paw), administered locally into the hindpaw, prevented hyperalgesia in a dose-dependent - 150 µg (- 9%), 300 µg (- 27%, P < 0.01), 600 µg (- 77%, P < 0.001) and 1000 µg (- 93%, P < 0.001) - and local manner. Mangiferin showed decreased levels of TNF-α (P < 0.001) and CINC-1 (P < 0.001), but not IL-1β; it also prevented neutrophil migration (P < 0.01), but not the increased COX-2 expression in peripheral tissue challenged with carrageenan. To further explore the mechanisms of mangiferin actions, rats were injected with modulators of inflammation and nociception; mangiferin prevented hyperalgesia induced by IL-1β (P < 0.01), CINC-1 (P < 0.01), epinephrine (P < 0.01), 8-Br-cAMP (P < 0.01) or capsaicin (P < 0.01), but not that induced by PGE 2 or α,β-MeATP. Our study shows that mangiferin has anti-inflammatory and analgesic properties when locally administrated. The control of the inflammatory response and mechanical hyperalgesia by mangiferin depends on the inhibition of TNF-α production/release and the CINC1/epinephrine/PKA pathway, supporting its marked inhibition of inflammatory mechanical hyperalgesia. Copyright © 2018 Elsevier B.V. All rights reserved.

Comparison of different cardiac relaxation indices.

PubMed

Alipov, N N; Izrail'tyan, I M; Sokolov, A V; Trubetskaya, L V; Kuznetsova, T E

2001-05-01

Sensitivity (response to epinephrine infusion) and specificity (response to changes in pre- and afterload) of some cardiac relaxation indices were compared in acute experiments on cats treated with ganglionic blocker arfonad. Some new indices proposed by us provide better characteristics than widely used relaxation time constant (t) and maximum first derivative of the left ventricular pressure (-dP/dt)max.

14 CFR Appendix A to Part 121 - First Aid Kits and Emergency Medical Kits

Code of Federal Regulations, 2013 CFR

2013-01-01

..., 50cc 1 Epinephrine 1:1000, single dose ampule or equivalent) 2 Diphenhydramine HC1 injection, single dose ampule or equivalent 2 Nitroglycerin tablets 10 Basic instructions for use of the drugs in the kit 1 protective nonpermeable gloves or equivalent 1 pair 2. As of April 12, 2004, at least one approved...

14 CFR Appendix A to Part 121 - First Aid Kits and Emergency Medical Kits

Code of Federal Regulations, 2010 CFR

2010-01-01

..., 50cc 1 Epinephrine 1:1000, single dose ampule or equivalent) 2 Diphenhydramine HC1 injection, single dose ampule or equivalent 2 Nitroglycerin tablets 10 Basic instructions for use of the drugs in the kit 1 protective nonpermeable gloves or equivalent 1 pair 2. As of April 12, 2004, at least one approved...

14 CFR Appendix A to Part 121 - First Aid Kits and Emergency Medical Kits

Code of Federal Regulations, 2014 CFR

2014-01-01

..., 50cc 1 Epinephrine 1:1000, single dose ampule or equivalent) 2 Diphenhydramine HC1 injection, single dose ampule or equivalent 2 Nitroglycerin tablets 10 Basic instructions for use of the drugs in the kit 1 protective nonpermeable gloves or equivalent 1 pair 2. As of April 12, 2004, at least one approved...

14 CFR Appendix A to Part 121 - First Aid Kits and Emergency Medical Kits

Code of Federal Regulations, 2011 CFR

2011-01-01

..., 50cc 1 Epinephrine 1:1000, single dose ampule or equivalent) 2 Diphenhydramine HC1 injection, single dose ampule or equivalent 2 Nitroglycerin tablets 10 Basic instructions for use of the drugs in the kit 1 protective nonpermeable gloves or equivalent 1 pair 2. As of April 12, 2004, at least one approved...

14 CFR Appendix A to Part 121 - First Aid Kits and Emergency Medical Kits

Code of Federal Regulations, 2012 CFR

2012-01-01

..., 50cc 1 Epinephrine 1:1000, single dose ampule or equivalent) 2 Diphenhydramine HC1 injection, single dose ampule or equivalent 2 Nitroglycerin tablets 10 Basic instructions for use of the drugs in the kit 1 protective nonpermeable gloves or equivalent 1 pair 2. As of April 12, 2004, at least one approved...

Time-dependent inactivation of human phenylethanolamine N-methyltransferase by 7-isothiocyanatotetrahydroisoquinoline

PubMed Central

Wu, Qian; Caine, Joanne M.; Thomson, Stuart A.; Slavica, Meri; Grunewald, Gary L.

2009-01-01

Inhibitors of phenylethanolamine N-methyltransferase [PNMT, the enzyme that catalyzes the final step in the biosynthesis of epinephrine (Epi)] may be of use in determining the role of Epi in the central nervous system. Here we describe the synthesis and characterization of 7-SCN tetrahydroisoquinoline as an affinity label for human PNMT. PMID:19171483

Acetylcholine Esterase Activity and Behavioral Response in Hypoxia Induced Neonatal Rats: Effect of Glucose, Oxygen and Epinephrine Supplementation

ERIC Educational Resources Information Center

Chathu, Finla; Krishnakumar, Amee; Paulose, Cheramadathikudyil S.

2008-01-01

Brain damage due to an episode of hypoxia remains a major problem in infants causing deficit in motor and sensory function. Hypoxia leads to neuronal functional failure, cerebral palsy and neuro-developmental delay with characteristic biochemical and molecular alterations resulting in permanent or transitory neurological sequelae or even death.…

Combined Effects of Microgravity, Radiation and Psychological Stress on Immune System Cells

NASA Technical Reports Server (NTRS)

Moreno-Villanueva, Maria

2017-01-01

The aim of this project was to investigate the combined effects of microgravity, radiation and psychological stress on DNA damage response. In order to mimic the combined conditions of space environment and psychological stress, cells were stimulated with isoproterenol (an epinephrine analogue compound) and exposed to radiation in a bioreactor that simulates microgravity conditions on the ground.

Variability of Hormonal Stress Markers Collected from a Managed Dolphin Population

DTIC Science & Technology

2011-09-30

physiological indicators of stress in wild marine mammals and the interrelationships between different stress markers can be used to estimate the impact of...samples will be processed for adrenocorticosteroids (ACTH, cortisol, aldosterone ), catecholamines (epinephrine, norepinephrine), and thyroid hormones...T3 and T4) via radioimmunoassay (RIA). Radioimmunoassay methods have previously been validated for cortisol and aldosterone in this species (Houser

Escherichia coli O157:H7 lacking qseBC encoded quorum sensing system outcompetes the parent strain in colonization of cattle intestine

USDA-ARS?s Scientific Manuscript database

The qseBC encoded quorum-sensing system (QS) regulates motility of enterohemorrhagic Escherichia coli (EHEC) O157:H7 in response to bacterial autoinducer-3 (AI-3) and mammalian stress hormones epinephrine (E) and norepinephrine (NE). The qseC gene encodes a sensory kinase that post-autophosphorylati...

Anaphylactic deaths in asthmatic patients.

PubMed

Settipane, G A

1989-01-01

We reviewed seven documented deaths to peanuts and two near deaths. We excluded hearsay undocumented deaths to peanuts. Peanut allergy is one of the most common food allergies and probably the most common cause of death by food anaphylaxis in the United States. About one-third of peanut-sensitive patients have severe reactions to peanuts. Asthmatics with peanut sensitivity appear more likely to develop fatal reactions probably because of the exquisite sensitivity that asthamatics have to chemical mediators of anaphylaxis. Severe reactions occur within a few minutes of ingestion and these patients must carry preloaded epinephrine syringes, antihistamines, and medic-alert bracelets. Treatment should include repeated doses of epinephrine, antihistamines and corticosteroids as well as availability of oxygen, mechanical methods to open airways, vasopressors, and intravenous fluids. Hidden sources of peanuts such as chili, egg rolls, cookies, candy, and pastry should be recognized and identified. Scratch/prick test to peanuts are highly diagnostic. Peanut is one of the most sensitive food allergens known requiring only a few milligrams to cause a reaction. In some individuals, even contact of peanut with unbroken skin can cause an immediate local reaction. Unfortunately, peanut reaction is not outgrown and remains a life-long threat.

Natalizumab Modifies Catecholamines Levels Present in Patients with Relapsing- Remitting Multiple Sclerosis.

PubMed

Escribano, Begona M; Aguilar-Luque, Macarena; Bahamonde, Carmen; Conde, Cristina; Lillo, Rafael; Sanchez-Lopez, Fernando; Giraldo, Ana I; Cruz, Antonio H; Luque, Evelio; Gascon, Felix; Aguera, Eduardo; Tunez, Isaac

2016-01-01

The main aim of this study was to verify the effect of natalizumab on the levels of circulating catecholamines and indolamine and their possible relation with MS. For this purpose, 12 healthy individuals (control group) and 12 relapsing-remitting multiple sclerosis patients (RR-MS) were selected. The patients were treated with 300 mg of natalizumab during 56 weeks (1 dose/4 weeks) (MS-56). This selection was based on the McDonalds revision criterion and scheduled to star treatment with natalizumab. Blood samples were taken before treatment (basal level) and after 56 weeks of using natalizumab. Melatonin was measured in serum and in plasma, catecholamines (dopamine, epinephrine, and norepinephrine), carbonylated proteins, 8-hydroxy-2'deoxyguanosine (8OH-dG) and the ratio reduced glutathione/oxidised glutathione (GSH/GSSG). The epinephrine and dopamine levels diminished in the basal group with respect to the control and did not recover normal levels with the treatment. The melatonin was decreased in RR-MS patients and went back to its normal levels with natalizumab. Norepinephrine was increased in RR-MS and decreased in MS-56 until it equalled the control group. Natalizumab normalizes altered melatonin and norepinephrine levels in MS.

Determination of dopamine, epinephrine, and norepinephrine by open-tubular capillary electrochromatography using graphene oxide molecularly imprinted polymers as the stationary phase.

PubMed

Ye, Nengsheng; Li, Jian

2014-08-01

A novel capillary electrochromatography method was developed for the determination of dopamine (DA), epinephrine (EP), and norepinephrine (NE) by using a graphene oxide (GO) molecularly imprinted polymers (MIPs) coated capillary. In this article, GO was introduced as supporting matrix to synthesize MIPs in the presence of DA as template molecule. Then GO MIPs were used as the stationary phase in electrochromatography for the determination of DA, EP, and NE. The separation of these three analytes was achieved under the optimal conditions with a satisfactory correlation coefficients (R(2) ) > 0.9957 in the range of 5.0-200.0 μg/mL for EP and NE, and 20.0-200.0 μg/mL for DA, respectively. The RSDs for the determination of three analytes were <6.19%, and the detection limits were 1.25 μg/mL for EP and NE, and 10.0 μg/mL for DA, respectively. Finally, this method was used for the determination of DA, EP, and NE in human serum and DA hydrochloride injection. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

STRUCTURE-FUNCTION RELATIONSHIPS IN THE ADIPOSE CELL

PubMed Central

Cushman, Samuel W.

1970-01-01

Pinocytic activity in the adipose cell has been examined by measuring the uptake of colloidal gold. Pinocytic activity occurs in the isolated adipose cell under all experimental conditions; a portion of the vesicular elements of the cell can be identified by electron microscopy as pinocytic in origin. The isolated adipose cell appears to take up serum albumin by pinocytosis. Pinocytic activity in the isolated adipose cell is enhanced by epinephrine, but not by insulin. The relationship between pinocytosis and the metabolic activity of the adipose cell has been studied by measuring simultaneously the uptake of radioactive colloidal gold, the incorporation of 14C-counts from U-glucose-14C into CO2, total lipid, triglyceride glycerol and triglyceride fatty acids, and the release of nonesterified fatty acids in the absence of hormones and in the presence of insulin or epinephrine. Correlations between hormone-produced alterations in lipid metabolism and in pinocytic activity suggest that intracellular nonesterified fatty acid levels are a factor in the regulation of both the cell's pinocytic activity and its metabolism and that pinocytosis in the adipose cell functions in the extracellular-intracellular transport of nonesterified fatty acids. PMID:5449179

3D cardiac μ tissues within a microfluidic device with real-time contractile stress readout

PubMed Central

Aung, Aereas; Bhullar, Ivneet Singh; Theprungsirikul, Jomkuan; Davey, Shruti Krishna; Lim, Han Liang; Chiu, Yu-Jui; Ma, Xuanyi; Dewan, Sukriti; Lo, Yu-Hwa; McCulloch, Andrew; Varghese, Shyni

2015-01-01

We present the development of three-dimensional (3D) cardiac microtissues within a microfluidic device with the ability to quantify real-time contractile stress measurements in situ. Using a 3D patterning technology that allows for the precise spatial distribution of cells within the device, we created an array of 3D cardiac microtissues from neonatal mouse cardiomyocytes. We integrated the 3D micropatterning technology with microfluidics to achieve perfused cell-laden structures. The cells were encapsulated within a degradable gelatin methacrylate hydrogel, which was sandwiched between two polyacrylamide hydrogels. The polyacrylamide hydrogels were used as “stress sensors” to acquire the contractile stresses generated by the beating cardiac cells. The cardiac-specific response of the engineered 3D system was examined by exposing it to epinephrine, an adrenergic neurotransmitter known to increase the magnitude and frequency of cardiac contractions. In response to exogenous epinephrine the engineered cardiac tissues exhibited an increased beating frequency and stress magnitude. Such cost-effective and easy-to-adapt 3D cardiac systems with real-time functional readout could be an attractive technological platform for drug discovery and development. PMID:26588203

Peripheral Circadian Clock Rhythmicity Is Retained in the Absence of Adrenergic Signaling

PubMed Central

Reilly, Dermot F.; Curtis, Anne M.; Cheng, Yan; Westgate, Elizabeth J.; Rudic, Radu D.; Paschos, Georgios; Morris, Jacqueline; Ouyang, Ming; Thomas, Steven A.; FitzGerald, Garret A.

2009-01-01

Objective The incidence of heart attack and stroke undergo diurnal variation. Molecular clocks have been described in the heart and the vasculature; however it is largely unknown how the suprachiasmatic nucleus (SCN) entrains these peripheral oscillators. Methods and Results Norepinephrine and epinephrine, added to aortic smooth muscle cells (ASMCs) in vitro, altered Per1, E4bp4, and dbp expression and altered the observed oscillations in clock gene expression. However, oscillations of Per1, E4bp4, dbp, and Per2 were preserved ex vivo in the aorta, heart, and liver harvested from dopamine β-hydroxylase knockout mice (Dbh−/−) that cannot synthesize either norepinephrine or epinephrine. Furthermore, clock gene oscillations in heart, liver, and white adipose tissue phase shifted identically in Dbh−/− mice and in Dbh+/− controls in response to daytime restriction of feeding. Oscillation of clock genes was similarly preserved ex vivo in tissues from Dbh+/− and Dbh−/− chronically treated with both propranolol and terazosin, thus excluding compensation by dopamine in Dbh−/− mice. Conclusions Although adrenergic signaling can influence circadian timing in vitro, peripheral circadian rhythmicity is retained despite its ablation in vivo. PMID:17975121

Adrenergic enhancement of consolidation of object recognition memory.

PubMed

Dornelles, Arethuza; de Lima, Maria Noemia Martins; Grazziotin, Manoela; Presti-Torres, Juliana; Garcia, Vanessa Athaide; Scalco, Felipe Siciliani; Roesler, Rafael; Schröder, Nadja

2007-07-01

Extensive evidence indicates that epinephrine (EPI) modulates memory consolidation for emotionally arousing tasks in animals and human subjects. However, previous studies have not examined the effects of EPI on consolidation of recognition memory. Here we report that systemic administration of EPI enhances consolidation of memory for a novel object recognition (NOR) task under different training conditions. Control male rats given a systemic injection of saline (0.9% NaCl) immediately after NOR training showed significant memory retention when tested at 1.5 or 24, but not 96h after training. In contrast, rats given a post-training injection of EPI showed significant retention of NOR at all delays. In a second experiment using a different training condition, rats treated with EPI, but not SAL-treated animals, showed significant NOR retention at both 1.5 and 24-h delays. We next showed that the EPI-induced enhancement of retention tested at 96h after training was prevented by pretraining systemic administration of the beta-adrenoceptor antagonist propranolol. The findings suggest that, as previously observed in experiments using aversively motivated tasks, epinephrine modulates consolidation of recognition memory and that the effects require activation of beta-adrenoceptors.

Neurohormonal and metabolic effects of medetomidine compared with xylazine in healthy cats

PubMed Central

Kanda, Teppei; Hikasa, Yoshiaki

2008-01-01

The purpose of this study was to investigate and compare the effects of medetomidine and xylazine on some neurohormonal and metabolic variables in healthy cats. Five cats were used repeatedly in each of 11 groups, which were injected intramuscularly with physiological saline solution (control), 20, 40, 80, 160, and 320 μg/kg of medetomidine, and 0.5, 1, 2, 4, and 8 mg/kg of xylazine. Blood samples were taken over 24 h from the jugular vein for determination of plasma glucose, insulin, cortisol, epinephrine, norepinephrine, glucagon, and nonesterified fatty acid concentrations. Both medetomidine and xylazine induced remarkable hyperglycemia that was dose-dependent except for the response to medetomidine from 0 to 3 h. Both agents suppressed epinephrine and norepinephrine release but not in a dose-dependent manner at the tested dosages. Both agents inhibited insulin release and lipolysis, with similar potency, and tended to suppress cortisol release. The glucagon levels did not change significantly in any of the groups. These results suggest that the effects of medetomidine and xylazine on glucose metabolism and catecholamine release may not be due only to the actions mediated by α2-adrenoceptors. PMID:18505192

[Approach and Registry of Anaphylaxis in Portugal].

PubMed

Mota, Inês; Pereira, Ana Margarida; Pereira, Celso; Tomaz, Elza; Ferreira, Manuel Branco; Sabino, Filipa; Coelho, Anabela; Santos, Anabela; Martins, Henrique; Morais-Almeida, Mário

2015-01-01

Anaphylaxis has a growing incidence, especially in children. It represents a medical emergency and its successful therapy depends on early and proper intervention. Intramuscular epinephrine, with dose adjustment according to weight and age, is the drug of choice for anaphylaxis treatment. After resolution of the acute reaction, the patient should be kept under clinical surveillance for 6 to 24 hours, due to possible biphasic reactions. Prescription of an epinephrine auto injectable device should be considered in all patients with diagnosed or suspected anaphylaxis; additionally these patients should always be referred to an Immunoallergy consultation, to perform adequate investigation and management in order to reduce future risk. All anaphylaxis episodes must be recorded in The Portuguese Catalogue of Allergies and other Adverse Reactions (Catálogo Português de Alergias e outras Reações Adversas, CPARA), which represents a fundamental tool to share clinical information within the Health System. The present manuscript intends to disclose the most recent Portuguese guidelines for the diagnosis and treatment of anaphylaxis, making its clinical approach more effective and homogeneous, and to promote the use of The Portuguese Catalogue of Allergies and other Adverse Reactions as an essential tool to register and share information on anaphylaxis in Portugal.

Evaluation of the anaesthetic properties and tolerance of 1:100,000 articaine versus 1:100,000 lidocaine. A comparative study in surgery of the lower third molar

PubMed Central

Barona-Dorado, Cristina; Martín-Arés, María; Cortés-Bretón-Brinkman, Jorge; Martínez-González, José M.

2012-01-01

Objectives: To evaluate the anaesthetic properties and tolerance of articaine versus lidocaine at equal vasoconstrictor concentration. Study Design: A total of 96 male and female patients who underwent surgical treatment of the lower third molar participated. Patients were randomly assigned to articaine hydrochloride with epinephrine 1:100,000 and lidocaine hydrochloride with epinephrine 1:100,000. The variables analysed were latency period, duration of anaesthetic effect, tolerance and adverse reactions. Results: Both the latency period and the duration of anaesthetic effect were greater for articaine, although the differences were not statistically significant. Latency: mean difference of 2.70 ± 2.12 minutes (95%CI of -1.51 minutes - 6.92 minutes). Duration: mean difference of -33 minutes 5 seconds ± 31 minutes (95% CI -1 hour 35 minutes - 29 minutes). There were 4 adverse events that did not require the patients to be withdrawn from the study. Conclusions: The anaesthetics in this study have very similar properties for use in surgery and have demonstrated a good safety and tolerability profile Key words: Articaine, lidocaine, vasoconstrictor, adverse reactions. PMID:22143691

Physiological changes, sleep, and morning mood in an isolated environment

NASA Technical Reports Server (NTRS)

Kraft, Norbert O.; Inoue, Natsuhiko; Mizuno, Koh; Ohshima, Hiroshi; Murai, Tadashi; Sekiguchi, Chiharu; Orasanu, J. M. (Principal Investigator)

2002-01-01

BACKGROUND: Previous isolation studies have shown increased 24-h urine volumes and body weight gains in subjects. This project examined those and other physiological variables in relationship to sleep motor activity, subjective sleep quality, mood, and complaints during confinement. METHODS: Six male and two female subjects lived for 7 d in the National Space Development Agency of Japan's isolation chamber, which simulates the interior of the Japanese Experiment Module. Each 24-h period included 6 h of sleep, 3 meals, and 20 min of exercise. Each morning, subjects completed Sleep Sensation and Complaint Index questionnaires. Catecholamine and creatinine excretion, urine volume, and body weight were measured on the 2 d before and 2 d after confinement, and sleep motor activity was measured during confinement. RESULTS: Confinement produced no significant change in body weight, urine volume, or questionnaire results. In contrast, epinephrine, norepinephrine, and sleep motor activity exhibited significant differences during confinement (p < 0.05). Higher nocturnal norepinephrine excretion correlated with higher sleep motor activity. CONCLUSION: The 24-h epinephrine values were slightly higher than normal throughout the experiment, but lower than for subjects working under time-stress. High sympathetic activity (as indicated by norepinephrine) may have interfered with sleep.

Angiotensin II or epinephrine hemodynamic and metabolic responses in the liver of L-NAME induced hypertension and spontaneous hypertensive rats

PubMed Central

Kimura, Debora Conte; Nagaoka, Marcia Regina; Borges, Durval Rosa; Kouyoumdjian, Maria

2017-01-01

AIM To study hepatic vasoconstriction and glucose release induced by angiotensin (Ang)II or Epi in rats with pharmacological hypertension and spontaneously hypertensive rat (SHR). METHODS Isolated liver perfusion was performed following portal vein and vena cava cannulation; AngII or epinephrine (Epi) was injected in bolus and portal pressure monitored; glucose release was measured in perfusate aliquots. RESULTS The portal hypertensive response (PHR) and the glucose release induced by AngII of L-NAME were similar to normal rats (WIS). On the other hand, the PHR induced by Epi in L-NAME was higher whereas the glucose release was lower compared to WIS. Despite the similar glycogen content, glucose release induced by AngII was lower in SHR compared to Wistar-Kyoto rats although both PHR and glucose release induced by Epi in were similar. CONCLUSION AngII and Epi responses are altered in different ways in these hypertension models. Our results suggest that inhibition of NO production seems to be involved in the hepatic effects induced by Epi but not by AngII; the diminished glucose release induced by AngII in SHR is not related to glycogen content. PMID:28660012

An Effect of Dexamethasone on Adenosine 3′,5′ -Monophosphate Content and Adenosine 3′,5′ -Monophosphate Phosphodiesterase Activity of Cultured Hepatoma Cells

PubMed Central

Manganiello, Vincent; Vaughan, Martha

1972-01-01

The effect of dexamethasone on adenosine 3′,5′-monophosphate (cAMP) phosphodiesterase activity in cultured HTC hepatoma cells was investigated. Homogenates of these cells contain phosphodiesterase activity with two apparent Michaelis constants for cAMP (2-5 μm and 50 μm). At all substrate concentrations tested, phosphodiesterase activity was decreased 25-40% in cells incubated for 36 hr or more with 1 μm dexamethasone. Acid phosphatase activity in the same cells was not decreased. α-Methyl testosterone, 1 μm, was without effect on phosphodiesterase activity. Incubation for 10 min with epinephrine plus theophylline increased the cAMP content of the HTC cells 3- to 6-fold. In cells incubated for 72 hr with dexamethasone, the basal concentration of cAMP was slightly increased and the increment produced by epinephrine plus theophylline was markedly increased. We believe that in many cells the so-called permissive effects of steroid hormones on cAMP mediated processes may be due to an effect of these hormones on cAMP phosphodiesterase activity similar to that observed in HTC cells incubated with dexamethasone. PMID:4341439

The Safety, Pharmacokinetics, and Nervous System Effects of Two Natural Sources of Caffeine in Healthy Adult Males.

PubMed

Krieger, D R; Kalman, D S; Feldman, S; Arnillas, L; Goldberg, D; Gisbert, O; Nader, S

2016-06-20

This double-blind crossover clinical trial randomized 12 adult males to receive 200 mg of caffeine from a green coffee extract, a guayusa leaf extract, and a synthetic control to compare their safety, absorption, and effect on neurotransmitters. The results showed no statistically significant changes in blood pressure or heart rate from baseline to 120 min postdose of each natural source compared with changes from baseline in the control (0.094 < = P < = 0.910). The ratios of C max , AUC 0-4 , and AUC 0-∞ of each natural source to the control were bioequivalent by US Food and Drug Administration standards (90% CI within 80-125%). The guayusa leaf extract stimulated a significantly lower increase in epinephrine compared with the control (+0.5 vs. +2.78 μg/gCr, P = 0.04), while the green coffee extract provoked an increase in epinephrine similar to the control (+3.21 vs. +2.78 μg/gCr, P = 0.569). Implications for future clinical research are discussed. © 2016 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wolfe, R.R.; Peters, E.J.; Klein, S.

In this study the rate of lipolysis (fatty acid and glycerol release into blood) has been quantified in both normal weight and obese volunteers after both 15 and 87 h of fasting. In each study, the basal rate and subsequent response to epinephrine infusion were determined. The rate of appearance (R/sub a/) of free fatty acids (FFA) and glycerol were quantified by infusion of (1- TC)palmitate and D-5-glycerol, respectively. Substrate flux rates per unit of body fat mass and lean body mass were calculated from total body water measurements using H2 YO dilution. In normal volunteers, the basal R/sub a/more » FFA and R/sub a/ glycerol rose markedly with 87 h of fasting, whereas the increases were more modest in the obese subjects. However, the rate of mobilization of fat, in relation to the lean body mass, was higher in the obese subjects than in the normal subjects after 15 h of fasting, and the values were similar in both groups after 87 h of fasting. There was an increased lipolytic response to epinephrine after fasting in both groups. This increased sensitivity may have resulted from the enhancement of fatty acid-triglyceride substrate cycling that occurred after fasting.« less

What factors affect the carriage of epinephrine auto-injectors by teenagers?

PubMed

Macadam, Clare; Barnett, Julie; Roberts, Graham; Stiefel, Gary; King, Rosemary; Erlewyn-Lajeunesse, Michel; Holloway, Judith A; Lucas, Jane S

2012-02-02

Teenagers with allergies are at particular risk of severe and fatal reactions, but epinephrine auto-injectors are not always carried as prescribed. We investigated barriers to carriage. Patients aged 12-18 years old under a specialist allergy clinic, who had previously been prescribed an auto-injector were invited to participate. Semi-structured interviews explored the factors that positively or negatively impacted on carriage. Twenty teenagers with food or venom allergies were interviewed. Only two patients had used their auto-injector in the community, although several had been treated for severe reactions in hospital. Most teenagers made complex risk assessments to determine whether to carry the auto-injector. Most but not all decisions were rational and were at least partially informed by knowledge. Factors affecting carriage included location, who else would be present, the attitudes of others and physical features of the auto-injector. Teenagers made frequent risk assessments when deciding whether to carry their auto-injectors, and generally wanted to remain safe. Their decisions were complex, multi-faceted and highly individualised. Rather than aiming for 100% carriage of auto-injectors, which remains an ambitious ideal, personalised education packages should aim to empower teenagers to make and act upon informed risk assessments.

Epinephrine in cardiac arrest: systematic review and meta-analysis.

PubMed

Morales-Cané, Ignacio; Valverde-León, María Del Rocío; Rodríguez-Borrego, María Aurora

2016-12-08

evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status. avaliar a efetividade da adrenalina na parada cardíaca e seu efeito na sobrevivência e no estado neurológico. revisão sistemática da literatura científica com meta-análise utilizando um modelo de efeitos aleatórios. Revisão em Medline, Embase e Cochrane, desde 2005 até 2015 de ensaios clínicos e estudos observacionais. observou-se aumento nas taxas de retorno de circulação espontânea com a administração de adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparadas com a não administração de adrenalina. A meta-análise mostrou um aumento da sobrevivência na alta ou depois de 30 dias da administração de adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). Quando estratificados por ritmos desfibrilháveis e não desfibrilháveis apareceu um aumento da sobrevivência nos ritmos não desfibrilháveis (OR 1,52; 95% IC 1,29-1,78; I2=42%). Também observou-se um incremento de sobrevivência na alta ou depois de 30 dias, quando administrada a adrenalina antes de 10 minutos, isto comparado com administração tardia (OR 2,03; 95% IC 1,77-2,32; I2=0%). a administração de adrenalina parece incrementar a taxa de retorno da circulação espontânea, mas não se tem encontrado um efeito positivo nas taxas de sobrevivência nem nas taxas de pacientes com estado neurológico favorável, em comparação com outras terapias. evaluar la efectividad de la adrenalina en el paro cardíaco y su efecto en la supervivencia y en el estado neurológico. revisión sistemática de la literatura científica con metaanálisis utilizando un modelo de efectos aleatorios. Revisión en Medline, Embase y Cochrane, desde 2005 hasta 2015, de ensayos clínicos y estudios observacionales. se observó aumento en las tasas de retorno de circulación espontánea cuando administrada adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparada con la no administración de adrenalina. El metaanálisis mostró un aumento de la supervivencia al alta hospitalaria o a los 30 días cuando administrada adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). La estratificación por ritmos desfibrilables y no desfibrilables mostró un aumento de la supervivencia en ritmos no desfibrilables (OR 1,52; 95% IC 1,29-1,78; I2=42%). También, se observó un incremento en la supervivencia al alta hospitalaria o a los 30 días en la administración de adrenalina antes de 10 minutos comparada con la administración tardía (OR 2,03; 95% IC 1,77-2,32; I2=0%). la administración de adrenalina parece incrementar la tasa de retorno de circulación espontánea, pero no se ha encontrado un efecto positivo en tasas de supervivencia ni en tasas de pacientes con estado neurológico favorable, en comparación con otras terapias.

Docosahexaenoic acid in cardiac metabolism and function.

PubMed

Gudbjarnason, S; Doell, B; Oskarsdóttir, G

1978-01-01

The polyene fatty acid compostition of cardiac phospholipids is modified by a) dietary cod liver oil, b) norepinephrine, c) chronic administration of nicotine to animals fed a high cholesterol diet. Polyene fatty acids stimulate microsomal oxydation of epinephrine to cardiotoxic adrenochrome. Adrenochrome stimulates microsomal peroxydation or oxygenation of polyene fatty acids. There is an exponential relationship between docosahexaenoic acid of cardiac phospholipids and the heart rate.

The Evaluation of a Food Allergy and Epinephrine Autoinjector Training Program for Personnel Who Care for Children in Schools and Community Settings

ERIC Educational Resources Information Center

Wahl, Ann; Stephens, Hilary; Ruffo, Mark; Jones, Amanda L.

2015-01-01

With the dramatic increase in the incidence of food allergies, nurses and other school personnel are likely to encounter a child with food allergies. The objectives of this study were to assess the effectiveness of in-person training on enhancing knowledge about food allergies and improving self-confidence in preventing, recognizing, and treating…

Effect of a Hypocretin/Orexin Antagonist on Neurocognitive Performance

DTIC Science & Technology

2010-09-01

Appendix 2), this milestone has been achieved as 26.05 g of >99% pure almorexant was delivered by the SRI Medicinal Chemistry Laboratory on 31 Mar...selectively disfacilitating the activity of the histaminergic, serotonergic , noradrenergic and cholinergic wake-promoting systems whereas the BzRA ZOL... Chemistry Laboratory. Appendix 3. Service report for the reinstallation and calibration of HPLC/EC system #1 (detection of norepinephrine, epinephrine

Review of Stress and the Measurement of Stress in Marine Mammals

DTIC Science & Technology

2013-09-30

massey.ac.nz Award Number: N000141110434 LONG-TERM GOALS Physiological indicators of stress in wild marine mammals, the interrelationships between...hormones (GC), aldosterone (A), thyroid hormones (TH), and catecholamines within a free-ranging northern elephant seal population and its dependence upon...individuals per year). Serum samples will be processed for ACTH, cortisol, aldosterone , catecholamines (epinephrine, norepinephrine), and TH (T3

Variability of Hormonal Stress Markers and Stress Responses in a Large Cross-Sectional Sample of Elephant Seals

DTIC Science & Technology

2011-09-30

massey.ac.nz Award Number: N000141110434 LONG-TERM GOALS Physiological indicators of stress in wild marine mammals, the interrelationships between...hormones (GC), aldosterone (A), thyroid hormones (TH), and catecholamines within a free-ranging northern elephant seal population and its...additional individuals per year). Serum samples will be processed for ACTH, cortisol, aldosterone , catecholamines (epinephrine, norepinephrine), and

[Ventricular fibrillation following deodorant spray inhalation].

PubMed

Girard, F; Le Tacon, S; Maria, M; Pierrard, O; Monin, P

2008-01-01

We report one case of out-of-hospital cardiac arrest with ventricular fibrillation following butane poisoning after inhalation of antiperspiration aerosol. An early management using semi-automatic defibrillator explained the success of the resuscitation. The mechanism of butane toxicity could be an increased sensitivity of cardiac receptors to circulating catecholamines, responsible for cardiac arrest during exercise and for resuscitation difficulties. The indication of epinephrine is discussed.

Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions.

PubMed

Goulet, J P; Pérusse, R; Turcotte, J Y

1992-11-01

This article discusses the relative contraindications to the use of vasoconstrictor in patients currently medicated with tricyclic antidepressants, monoamine oxidase inhibitors, phenothiazines and beta-blockers. It reviews drug interactions and emphasizes potential detrimental systemic effects that epinephrine contained in local anesthetics can have when administered concomitantly with these drugs. Finally, special considerations are expressed concerning patients who abuse illicit drugs such as cocaine.

Journal of Special Operations Medicine, Volume 6, Edition 3

DTIC Science & Technology

2006-01-01

between the lower leg muscular planes. These are often times located in multiple places and not radiographically detectable. Volume 6, Edition 3...tinged. Physical examination was remarkable for rales and rhonchi at the left base. There was no jugular venous distension or tracheal deviation... muscular or subcutaneous epinephrine are the first-line treatments for these rare but serious conditions; respi- ratory and intravascular fluid may

Space motion sickness medications: interference with biomedical parameters

NASA Technical Reports Server (NTRS)

Vernikos-Danellis, J.; Winget, C. M.; Leach, C. S.; Rosenblatt, L. S.; Lyman, J.; Beljan, J. R.

1977-01-01

The possibility that drugs administered to Skylab 3 (SL-3) and 4 (SL-4) crewmen for space motion sickness may have interfered with their biomedical evaluation in space was investigated. Healthy volunteers received combinations of Scopolamine/Dexedrine for four days in regimens similar to those used in these missions. Urine samples, heart rate, body temperature, mood and performance were analyzed for drug-related changes. Twenty-four hour urine samples were analyzed by the same procedures as those used to analyze the flight samples. Hormone concentrations determined included cortisol, epinephrine, norepinephrine, aldosterone and antidiuretic hormone (ADH). In addition, volume, specific gravity, osmolarity, sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), chloride (Cl), inorganic phosphate, uric acid and creatinine were measured. Performance was not affected by the Scopolamine/Dexedrine. The drug combination increased daily mean heart rate (HR) significantly in all the subjects and daily mean rectal temperature (RT) in some of the subjects. A 2-4 hr phase shift in the HR circadian rhythm was also observed which indicates that internal circadian synchrony was disturbed by the drugs. Psychological and subjective evaluation indicated that the subjects could usually identify which days they were given the drugs by an increase in tension and anxiety, decreased patience, restlessness, decreased appetite, difficulty in sleeping and feelings of increased heart rate and body temperature. Urinary electrolytes were not changed significantly by the drug, but marked and significant changes occurred in urine volume and hormone excretion patterns. Scopolamine/Dexedrine caused consistent elevations in urinary cortisol and epinephrine and a transient elevation in ADH. Norepinephrine excretion was decreased, but there was no significant change in aldosterone excretion or in 24 hr urine volume. A comparison of these findings with the first four days of inflight data from the SL-3 and SL-4 missions leads to the conclusion that the dramatic increases in aldosterone excretion during the first three days of spaceflight probably can be directly attributed to weightlessness, whereas the antimotion sickness medication could have substantially contributed to the early increased excretion of epinephrine and cortisol during these missions.

Chrysophyllum cainito leaves are effective against pre-clinical chronic pain models: Analysis of crude extract, fraction and isolated compounds in mice.

PubMed

Meira, Nicole Anzanelo; Rocha, Lilian W; da Silva, Gislaine F; Quintal, Zhelmy Martin; Delle Monache, Franco; Cechinel Filho, Valdir; Quintão, Nara Lins Meira

2016-05-26

Chrysophyllum cainito L. (Sapotaceae), commonly known as caimito or star apple, is a neotropical tree valued for its ornamental quality and edible fruits. Besides its culinary use, the leaves are also popularly used to treat diabetes mellitus and several inflammatory diseases. This study aimed to complement previous data obtained about the anti-hypersensitivity effects of the crude methanol extract (CME), CHCl3 fraction and isolated compounds obtained from C. cainito. The CME, CHCl3 fraction and two isolated triterpenes identified as 3β-Lup-20(29)-en-3-yl acetate (1) and Lup-20(29)-en-3β-O-hexanoate (2) were evaluated regarding their effects using clinical pain models, such as post-operative, inflammatory and neuropathic pain. Acute inflammatory pain models induced by PGE2, epinephrine, LPS and CFA were also used to improve the knowledge about the mechanism of action. The animals treated with the CME and submitted to PGE2, epinephrine, LPS or CFA had the mechanical hypersensitivity significantly reduced. When repeatedly administered, the CME enhanced the mechanical withdrawal threshold of mice submitted to post-operative pain model, CFA-induced chronic inflammatory pain and two different models of neuropathic pain. In turn, the CHCl3 fraction presented anti-hypersensitivity effect against epinephrine- or LPS-induced hypersensitivity, with a more prominent activity in both the neuropathic pain models. The compound 1 seems to present the same profile of the CHCl3, whereas compound 2 exhibited activity similar to the CME. This data suggests that the CME effect involves interference in the production, release or action of some chemical mediators, such as PGE2, sympathetic amines, cytokines, etc. Part of these effects was observed with the CHCl3 fraction, emphasizing the prominent inhibition of neuropathic pain. The results also demonstrated that part of the CME effects are due to the presence of the triterpenes 1 and 2, but it is important to mention that we cannot discard the effects of countless other compounds presented in the crude extract, acting in a synergic way. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Efficacy of mepivacaine-tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial.

PubMed

Rodríguez-Wong, L; Pozos-Guillen, A; Silva-Herzog, D; Chavarría-Bolaños, D

2016-04-01

To compare the success of an inferior alveolar nerve block (IANB) after injecting a combination of mepivacaine and tramadol or mepivacaine alone in patients with symptomatic irreversible pulpitis (SIP) in mandibular permanent molars. This study was a double-blind, randomized, controlled clinical trial. Two study groups were selected, each consisting of 28 patients who exhibited SIP on the first or second mandibular molars. All included patients presented with moderate-to-severe preoperative pain according to the modified Heft-Parker visual analogue scale (VAS). Patients were anaesthetized using the IANB technique employing identical cartridges that contained either 1.3 mL of 2% mepivacaine with epinephrine 1 : 100 000 plus 0.5 mL of tramadol 50 mg mL(-1) (experimental group) or 1.8 mL of 2% mepivacaine with epinephrine 1 : 100 000 (control group). After 15 min, anaesthesia was evaluated by a progressive four-test examination, that is numbness of the lip, positive or negative cold test, asymptomatic management of dental hard tissues and access to dental pulp. Success of the IANB was defined as the absence of pain during any of these evaluations. The data were analysed with a chi-square, Fisher's or Mann-Whitney U test. A total of 74 patients were initially assessed, with 56 patients eventually included and 18 excluded. No significant differences in age (P = 0.384) or gender (P = 1) were found between the two groups. The success rates of anaesthesia with the IANB for the experimental and control groups were 57.1 and 46.4%, respectively. The success rate of anaesthesia in the experimental group was not significantly different (P ˃ 0.05) from that of the control group. The duration of the anaesthetic effect was significantly longer for the experimental group (P = 0.026). The combination of mepivacaine-tramadol achieved similar success rates for IANB when compared to mepivacaine 2% epinephrine 1 : 100 000. There was no significant difference in the anaesthetic efficacy between the control and experimental solutions, and none of the solutions tested were completely successful. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Bombesin-like peptides stimulate somatostatin release from rat fundic D cells in primary culture.

PubMed

Schaffer, K; Herrmuth, H; Mueller, J; Coy, D H; Wong, H C; Walsh, J H; Classen, M; Schusdziarra, V; Schepp, W

1997-09-01

In several species, bombesin-like neuropeptides stimulate somatostatin release in in vitro preparations of gastric mucosa. We sought to determine if this response is due to a direct effect on fundic D cells. Rat fundic mucosal cells were isolated by pronase E (1% D cells). D cells were separated by counterflow elutriation and subsequent density-gradient centrifugation (Nycodenz) (15% D cells) and grown in primary culture for 48 h (46% D cells). Cultured cells were double stained with affinity-purified rabbit-anti-gastrin-releasing peptide (GRP) receptor antibody and mouse monoclonal antibody to human somatostatin. After incubation with rhodamine-labeled anti-rabbit and fluorescein isothiocyanate-labeled anti-mouse antibodies, reactions were visualized by fluorescence microscopy. All cells positive for somatostatin had GRP receptors, whereas all non-D cells showed no expression in this G cell-free culture system. Somatostatin release from cultured cells was stimulated by sulfated cholecystokinin octapeptide (CCK-8; EC50 3 X 10(-10) M) and epinephrine (EC50 4 X 10(-8) M), which are established stimuli for canine fundic D cells. Bombesin (EC50 6 X 10(-11) M), its mammalian analog GRP-27, and neuromedin C (GRP-10) (EC50 1 X 10(-10) M, for both) were almost equally potent stimuli of somatostatin release, eliciting maximal response at 10(-9) M (400-550% above basal). Neuromedin B was less potent and effective (maximal response at 10(-8) M, 230% above basal). [D-Phe6]bombesin-(6-13)-OMe, a specific bombesin receptor antagonist, inhibited bombesin-stimulated somatostatin release in a competitive manner (IC50 9 X 10(-8) M). Potentiating interactions were observed between bombesin and dibutyryladenosine 3',5'-cyclic monophosphate (DBcAMP) or epinephrine, but not between bombesin and CCK-8. We conclude that bombesin-like peptides directly stimulate somatostatin release by interacting with specific receptors on rat fundic D cells. Bombesin-like peptides appear to induce Ca(2+)-phospholipid-dependent signal-response transduction, as is indirectly suggested by potentiating interactions with DBcAMP or epinephrine.

p-( sup 125 I)iodoclonidine is a partial agonist at the alpha 2-adrenergic receptor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gerhardt, M.A.; Wade, S.M.; Neubig, R.R.

1990-08-01

The binding properties of p-(125I)iodoclonidine (( 125I)PIC) to human platelet membranes and the functional characteristics of PIC are reported. (125I)PIC bound rapidly and reversibly to platelet membranes, with a first-order association rate constant (kon) at room temperature of 8.0 +/- 2.7 x 10(6) M-1 sec-1 and a dissociation rate constant (koff) of 2.0 +/- 0.8 x 10(-3) sec-1. Scatchard plots of specific (125I)PIC binding (0.1-5 nM) were linear, with a Kd of 1.2 +/- 0.1 nM. (125I)PIC bound to the same number of high affinity sites as the alpha 2-adrenergic receptor (alpha 2-AR) full agonist (3H) bromoxidine (UK14,304), which representedmore » approximately 40% of the sites bound by the antagonist (3H)yohimbine. Guanosine 5'-(beta, gamma-imido)triphosphate greatly reduced the amount of (125I)PIC bound (greater than 80%), without changing the Kd of the residual binding. In competition experiments, the alpha 2-AR-selective ligands yohimbine, bromoxidine, oxymetazoline, clonidine, p-aminoclonidine, (-)-epinephrine, and idazoxan all had Ki values in the low nanomolar range, whereas prazosin, propranolol, and serotonin yielded Ki values in the micromolar range. Epinephrine competition for (125I)PIC binding was stereoselective. Competition for (3H)bromoxidine binding by PIC gave a Ki of 1.0 nM (nH = 1.0), whereas competition for (3H)yohimbine could be resolved into high and low affinity components, with Ki values of 3.7 and 84 nM, respectively. PIC had minimal agonist activity in inhibiting adenylate cyclase in platelet membranes, but it potentiated platelet aggregation induced by ADP with an EC50 of 1.5 microM. PIC also inhibited epinephrine-induced aggregation, with an IC50 of 5.1 microM. Thus, PIC behaves as a partial agonist in a human platelet aggregation assay. (125I)PIC binds to the alpha 2B-AR in NG-10815 cell membranes with a Kd of 0.5 +/- 0.1 nM.« less

Urinary catecholamines, plasma insulin and environmental factors in relation to body fat distribution.

PubMed

Leonetti, D L; Bergstrom, R W; Shuman, W P; Wahl, P W; Jenner, D A; Harrison, G A; Fujimoto, W Y

1991-05-01

The relationship of body fat distribution to insulin and the catecholamines, hormones that affect lipolysis differentially by fat site, was examined within an environmental context, including factors of medication use, physical activity, dietary intake, educational attainment, and age. Four cross-sectional body fat areas (cm2) were determined by three computed tomography (CT) scans (subcutaneous chest fat at the level of the nipples, subcutaneous and intra-abdominal fat at the level of the umbilicus, and subcutaneous left mid-thigh fat) in 191 second-generation Japanese-American men aged 45-74 years. The site-specific fat measurements were first examined in relation to use of beta-adrenergic antagonists, then to fasting plasma insulin and C-peptide levels and to urinary epinephrine and norepinephrine levels from a 24-h urine collection made during usual daily activities. Greater fat stores in the intra-abdominal area, even after adjustment for body mass index (BMI, weight/height2) and presence of coronary heart disease, were found to be related to use of beta-adrenergic antagonists. In men taking no adrenergic antagonists (n = 157), after adjustment for BMI, truncal fat measurements of the chest (partial r = -0.16, P less than 0.05) and intra-abdominal area (partial r = -0.21, P less than 0.05) were found to be inversely related to epinephrine, and intra-abdominal fat (partial r = 0.25, P less than 0.01) alone was directly related to fasting plasma insulin. With respect to other environmental variables, the significant inverse relationship of intra-abdominal fat (adjusted for BMI) with physical activity (partial r = -0.17, P less than 0.05) and the significant difference in intra-abdominal fat by educational attainment (college 102.3 +/- 5.7 vs no college 115.7 +/- 6.1 cm2, P = 0.03) became non-significant with adjustment, using multiple regression analysis, for insulin in the case of physical activity and epinephrine in the case of educational attainment. Thus, intra-abdominal fat showed a unique set of relationships to metabolic parameters which could be further related to certain environmental variables.

Military Nutrition Research: Four Tasks to Address Personnel Readiness and Warfighter Performance

DTIC Science & Technology

2007-03-01

insulin, free fatty acids, beta hydroxybutyrate, glucagon, and IGF-1, epinephrine, norepinephrine, urine creatinine, urine total nitrogen, urine urea...project. • Completion of blood testing for Project 4. Specifically, the following tests were completed: AST, beta hydroxybutyrate, blood urea...Minehira, J-M Schwarz, K Acheson, P Schneiter, J Burri, E Jequier, and L Tappy. Mechanisms of action of ß- glucan in postprandial glucose metabolism

Behavioral Response of Dolphins to Signals Simulating Mid-Frequency Sonar

DTIC Science & Technology

2011-09-30

following, and for several days to a week following the sound exposure. Blood collections will be analyzed for cortisol and aldosterone and inspected...of corticosteroid hormones (cortisol and aldosterone ) and epinephrine. Levels will be compared between categories and related to exposure level to...distribution of responses by age and experience can probably be expected from wild populations as well. A lack of any physiological indicator of an

Variability of Hormonal Stress Markers and Stress Responses in a Large Cross-Sectional Sample of Elephant Seals

DTIC Science & Technology

2012-09-30

Award Number: N000141110434 LONG-TERM GOALS Physiological indicators of stress in wild marine mammals, the interrelationships between...populations. OBJECTIVES The objectives of this effort are to: 1) determine the variation in glucocorticoid hormones (GC), aldosterone (A), thyroid...will be processed for ACTH, cortisol, aldosterone , catecholamines (epinephrine, norepinephrine), and TH (T3 and T4) via radioimmunoassay (RIA). All

Potential Life-Threatening Events in Schools Involving Rescue Inhalers, Epinephrine Autoinjectors, and Glucagon Delivery Devices: Reports from School Nurses

ERIC Educational Resources Information Center

Allen, Katherine; Henselman, Kimbra; Laird, Brian; Quinones, Ana; Reutzel, Thomas

2012-01-01

The purpose of this research is to use the reports of school nurses to facilitate the understanding of how schools experience and manage asthmatic, anaphylactic, and diabetic emergencies by quantitative and qualitative analysis of online surveys. E-mails with a link to SurveyMonkey[R] were sent to all U.S. members of the National Association of…

Effect of Chronic Hypercapnia on Body Temperature Regulation

DTIC Science & Technology

1974-08-01

has found further support by Cranston, et al8 providing evidence concerning the effects of endogenous noradrenaline changes upon body tem...produced in chronic hypercapnia in guinea pigs are related to the changes in the concen- trations of the endogenous epinephrine and serotonin in the...Luff, R. H. and Rawlins, M. D. Evidence concerning the effects of endogenous noradrenaline upon body temperature in cats and rabbits. J Physiol 212

Mathematical Model Analysis of Heart-Arterial Interaction in Hypertension

DTIC Science & Technology

2001-10-25

conscious dogs with dilated cardiomyopathy ,” ! " # , vol. 260, pp. H1903-H1911, 1991. [7] P. Segers, N...with data measured in the isolated canine [14] or cat [15] heart, pumping into an artificial load or in the intact sheep [16] and human [7]. Left...instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio,” , vol. 32, pp. 314

What factors affect the carriage of epinephrine auto-injectors by teenagers?

PubMed Central

2012-01-01

Background Teenagers with allergies are at particular risk of severe and fatal reactions, but epinephrine auto-injectors are not always carried as prescribed. We investigated barriers to carriage. Methods Patients aged 12-18 years old under a specialist allergy clinic, who had previously been prescribed an auto-injector were invited to participate. Semi-structured interviews explored the factors that positively or negatively impacted on carriage. Results Twenty teenagers with food or venom allergies were interviewed. Only two patients had used their auto-injector in the community, although several had been treated for severe reactions in hospital. Most teenagers made complex risk assessments to determine whether to carry the auto-injector. Most but not all decisions were rational and were at least partially informed by knowledge. Factors affecting carriage included location, who else would be present, the attitudes of others and physical features of the auto-injector. Teenagers made frequent risk assessments when deciding whether to carry their auto-injectors, and generally wanted to remain safe. Their decisions were complex, multi-faceted and highly individualised. Conclusions Rather than aiming for 100% carriage of auto-injectors, which remains an ambitious ideal, personalised education packages should aim to empower teenagers to make and act upon informed risk assessments. PMID:22409884

Immunotoxic destruction of distinct catecholaminergic neuron populations disrupts the reproductive response to glucoprivation in female rats.

PubMed

I'Anson, Helen; Sundling, Lois A; Roland, Shannon M; Ritter, Sue

2003-10-01

We tested the hypothesis that hindbrain catecholamine (norepinephrine or epinephrine) neurons, in addition to their essential role in glucoprivic feeding, are responsible for suppressing estrous cycles during chronic glucoprivation. Normally cycling female rats were given bilateral injections of the retrogradely transported ribosomal toxin, saporin, conjugated to monoclonal dopamine beta-hydroxylase antibody (DSAP) into the paraventricular nucleus (PVN) of the hypothalamus to selectively destroy norepinephrine and epinephrine neurons projecting to the PVN. Controls were injected with unconjugated saporin. After recovery, we assessed the lesion effects on estrous cyclicity under basal conditions and found that DSAP did not alter estrous cycle length. Subsequently, we examined effects of chronic 2-deoxy-d-glucose-induced glucoprivation on cycle length. After two normal 4- to 5-d cycles, rats were injected with 2-deoxy-d-glucose (200 mg/kg every 6 h for 72 h) beginning 24 h after detection of estrus. Chronic glucoprivation increased cycle length in seven of eight unconjugated saporin rats but in only one of eight DSAP rats. Immunohistochemical results confirmed loss of dopamine beta-hydroxylase immunoreactivity in PVN. Thus, hindbrain catecholamine neurons with projections to the PVN are required for inhibition of reproductive function during chronic glucose deficit but are not required for normal estrous cyclicity when metabolic fuels are in abundance.

Multifunctional Polyphenols- and Catecholamines-Based Self-Defensive Films for Health Care Applications.

PubMed

Dhand, Chetna; Harini, Sriram; Venkatesh, Mayandi; Dwivedi, Neeraj; Ng, Alice; Liu, Shouping; Verma, Navin Kumar; Ramakrishna, Seeram; Beuerman, Roger W; Loh, Xian Jun; Lakshminarayanan, Rajamani

2016-01-20

In an era of relentless evolution of antimicrobial resistance, there is an increasing demand for the development of efficient antimicrobial coatings or surfaces for food, biomedical, and industrial applications. This study reports the laccase-catalyzed room-temperature synthesis of mechanically robust, thermally stable, broad spectrum antimicrobial films employing interfacial interactions between poly(vinyl alcohol), PVA, and 14 naturally occurring catecholamines and polyphenols. The oxidative products of catecholamines and polyphenols reinforce the PVA films and also alter their surface and bulk properties. Among the catecholamines-reinforced films, optimum surface and bulk properties can be achieved by the oxidative products of epinephrine. For polyphenols, structure-property correlation reveals an increase in surface roughness and elasticity of PVA films with increasing number of phenolic groups in the precursors. Interestingly, PVA films reinforced with oxidized/polymerized products of pyrogallol (PG) and epinephrine (EP) display potent antimicrobial activity against pathogenic Gram-positive and Gram-negative strains, whereas hydroquinone (HQ)-reinforced PVA films display excellent antimicrobial properties against Gram-positive bacteria only. We further demonstrate that HQ and PG films retain their antimicrobial efficacy after steam sterilization. With an increasing trend of giving value to natural and renewable resources, our results have the potential as durable self-defensive antimicrobial surfaces/films for advanced healthcare and industrial applications.

Clinical and laboratory 2-year outcome of oral immunotherapy in patients with cow's milk allergy.

PubMed

Elizur, A; Appel, M Y; Goldberg, M R; Yichie, T; Levy, M B; Nachshon, L; Katz, Y

2016-02-01

Studies examining the long-term effect of oral immunotherapy in food-allergic patients are limited. We investigated cow's milk-allergic patients, >6 months after the completion of oral immunotherapy (n = 197). Questionnaires, skin prick tests, and basophil activation assays were performed. Of the 195 patients contacted, 180 (92.3%) were consuming milk protein regularly. Half experienced adverse reactions, mostly mild. Thirteen patients (6.7%) required injectable epinephrine. Higher reaction rate after immunotherapy was associated with more anaphylactic episodes before treatment and a lower starting dose (OR = 2.1, P = 0.035 and OR = 2.3, P = 0.035, respectively). Reaction rate in patients who were 6-15 months, 15-30 months, or >30 months post-treatment decreased from 0.28/month to 0.21/month to 0.15/month, respectively (P < 0.01). Milk-induced %CD63 and %CD203c expression was significantly lower in patients >24 months vs in patients <24 months post-treatment (P = 0.038 and P = 0.047, respectively). In conclusion, many patients experience mild adverse reactions after completing oral immunotherapy and some require injectable epinephrine. Progressive desensitization, both clinically and in basophil reactivity, occurs over time. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A study on reducing the absorption of lidocaine from the airway in cats.

PubMed

Chen, Yunfeng; Zeng, Yiming; Zhang, Yin

2017-08-01

To determine if the combination of lidocaine with epinephrine or gamma globulin would decrease the rate or reduce the amount of local absorption of lidocaine through the airway. Twenty adult male cats were randomly and evenly distributed into four groups: 1) Group LG: lidocaine administered with gamma globulin; 2) Group LS: lidocaine administered with physiological saline); 3) Group LE: lidocaine administered with epinephrine; 4) Group C: control group. Invasive blood pressure, heart rate, and concentration of lidocaine were recorded before and after administration. The peak of plasma concentrations appeared difference (Group LG: 1.39 ± 0.23 mg/L; Group LS: 1.47 ± 0.29 mg/L and Group LE: 0.99 ± 0.08 mg/L). Compared to Group C, there were significant differences in the average heart rate of Groups LG, LS, and LE (P < 0.05). The average systolic blood pressures were significantly different when each group was compared to Group C (P < 0.05). The biological half-life, AUC0-120, peak time, and half-life of absorption among the three groups have not presented statistically significant differences (P > 0.05). Administering lidocaine in combination with gamma globulin through airway causes significant decrease the rate and reduce the amount of local absorption of lidocaine in cats.

The effect of working on-call on stress physiology and sleep: A systematic review.

PubMed

Hall, Sarah J; Ferguson, Sally A; Turner, Anne I; Robertson, Samuel J; Vincent, Grace E; Aisbett, Brad

2017-06-01

On-call work is becoming an increasingly common work pattern, yet the human impacts of this type of work are not well established. Given the likelihood of calls to occur outside regular work hours, it is important to consider the potential impact of working on-call on stress physiology and sleep. The aims of this review were to collate and evaluate evidence on the effects of working on-call from home on stress physiology and sleep. A systematic search of Ebsco Host, Embase, Web of Science, Scopus and ScienceDirect was conducted. Search terms included: on-call, on call, standby, sleep, cortisol, heart rate, adrenaline, noradrenaline, nor-adrenaline, epinephrine, norepinephrine, nor-epinephrine, salivary alpha amylase and alpha amylase. Eight studies met the inclusion criteria, with only one study investigating the effect of working on-call from home on stress physiology. All eight studies investigated the effect of working on-call from home on sleep. Working on-call from home appears to adversely affect sleep quantity, and in most cases, sleep quality. However, studies did not differentiate between night's on-call from home with and without calls. Data examining the effect of working on-call from home on stress physiology were not sufficient to draw meaningful conclusions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hypertonic saline-epinephrine local injection therapy for post-endoscopic sphincterotomy bleeding: removal of blood clots using pure ethanol local injection.

PubMed

Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Nishikawa, Takao; Kurosawa, Jo; Saito, Masayoshi; Tawada, Katsunobu; Mikata, Rintaro; Tada, Motohisa; Ishihara, Takeshi; Yokosuka, Osamu

2013-08-01

Bleeding following endoscopic sphincterotomy (EST) is a rare but unavoidable complication of the procedure. We routinely perform local injection of hypertonic saline-epinephrine (HSE) for the treatment of post-EST bleeding. Any blood clot is removed only by irrigation with water after local injection of pure ethanol into the blood clot to cause crusting. We evaluated the usefulness of this treatment method. Subjects were 8 patients (1.2%) with post-EST bleeding requiring hemostatic intervention among 682 patients undergoing EST. After determination of the bleeding point, local injection of HSE was performed. When an adherent blood clot was present, pure ethanol was injected into the blood clot and then irrigation with water was performed to remove the blood clot. Endoscopic hemostasis was successfully achieved in all the 8 patients (100%). In 4 patients (50%), the adherent blood clots were successfully removed only with pure ethanol local injection into the blood clot followed by irrigation with water. No complications of the hemostatic procedure occurred in any patients. This study indicated that hemostasis with HSE local injection can be safe and useful for the treatment of post-EST bleeding, and also that blood clot removal with pure ethanol local injection can be useful.

Anaphylaxis in dogs and cats.

PubMed

Shmuel, Daniella L; Cortes, Yonaira

2013-01-01

To review and summarize current information regarding the pathophysiology and clinical manifestations associated with anaphylaxis in dogs and cats. The etiology, diagnosis, treatment, and prognosis is discussed. Anaphylaxis is a systemic, type I hypersensitivity reaction that often has fatal consequences. Many of the principal clinical manifestations involve organs where mast cell concentrations are highest: the skin, the lungs, and the gastrointestinal tract. Histamine and other deleterious inflammatory mediators promote vascular permeability and smooth muscle contraction; they are readily released from sensitized mast cells and basophils challenged with antigen. Anaphylaxis may be triggered by a variety of antigens including insect and reptile venom, a variety of drugs, vaccines, and food. Anaphylaxis is a clinical diagnosis made from a collection of signs and symptoms. It is most commonly based on pattern recognition. Differential diagnoses include severe asthma, pheocromocytoma, and mastocytosis. Epinephrine is considered the drug of choice for the treatment of anaphylaxis. It acts primarily as a vasopressor in improving hemodynamic recovery. Adjunctive treatments include fluid therapy, H1 and H2 antihistamines, corticosteroids, and bronchodilators; however, these do not substitute for epinephrine. Prognosis depends on the severity of the clinical signs. The clinical signs will vary among species and route of exposure. The most severe clinical reactions are associated when the antigen is administered parenterally. © Veterinary Emergency and Critical Care Society 2013.

The Neuro-Hormonal Control of Rapid Dynamic Skin Colour Change in an Amphibian during Amplexus

PubMed Central

Kindermann, Christina; Narayan, Edward J.; Hero, Jean-Marc

2014-01-01

Sexual signalling using dynamic skin colouration is a key feature in some vertebrates; however, it is rarely studied in amphibians. Consequently, little is known about the hormonal basis of this interesting biological phenomenon for many species. Male stony creek frogs (Litoria wilcoxii) are known to change dorsal colouration from brown to lemon yellow within minutes. This striking change is faster then what has been seen most amphibians, and could therefore be under neuronal regulation, a factor that is rarely observed in amphibians. In this study, we observed colour changes in wild frogs during amplexus to determine the natural timing of colour change. We also investigated the hypothesis that colour change is mediated by either reproductive or neuro- hormones. This was achieved by injecting frogs with epinephrine, testosterone, saline solution (control 1) or sesame oil (control 2). A non-invasive approach was also used wherein hormones and controls were administered topically. Male frogs turned a vivid yellow within 5 minutes of initiation of amplexus and remained so for 3–5 hours before rapidly fading back to brown. Epinephrine-treated frogs showed a significant colour change from brown to yellow within 5 minutes, however, testosterone-treated frogs did not change colour. Our results provide evidence of the role neuronal regulation plays in colour change systems. PMID:25470775

Increased platelet reactivity in HIV-1-infected patients receiving abacavir-containing antiretroviral therapy.

PubMed

Satchell, Claudette S; O'Halloran, Jane A; Cotter, Aoife G; Peace, Aaron J; O'Connor, Eileen F; Tedesco, Anthony F; Feeney, Eoin R; Lambert, John S; Sheehan, Gerard J; Kenny, Dermot; Mallon, Patrick W G

2011-10-15

Current or recent use of abacavir for treating human immunodeficiency virus type 1 (HIV-1) infection has been associated with increased rates of myocardial infarction (MI). Given the role of platelet aggregation in thrombus formation in MI and the reversible nature of the abacavir association, we hypothesized that patients treated with abacavir would have increased platelet reactivity. In a prospective study in adult HIV-infected patients, we determined associations between antiretrovirals (ARVs), and in particular the nucleoside reverse transcriptase inhibitor abacavir, and platelet reactivity by measuring time-dependent platelet aggregation in response to agonists: adenosine diphosphate (ADP), thrombin receptor-activating peptide (TRAP), collagen, and epinephrine. Of 120 subjects, 40 were ARV-naive and 80 ARV-treated, 40 of whom were receiving abacavir. No consistent differences in platelet reactivity were observed between the ARV-naive and ARV-treated groups. In contrast, within the ARV-treated group, abacavir-treated subjects had consistently higher percentages of platelet aggregation upon exposure to ADP, collagen, and epinephrine (P = .037, P = .022, and P = .032, respectively) and had platelets that were more sensitive to aggregation upon exposure to TRAP (P = .025). The consistent increases in platelet reactivity observed in response to a range of agonists provides a plausible underlying mechanism to explain the reversible increased rates of MI observed in abacavir-treated patients.

Managing food allergies in schools.

PubMed

Portnoy, Jay M; Shroba, Jodi

2014-10-01

Food allergies are estimated to affect as many as 8 % of children with 2.5 % being allergic to peanut products. Based on the results of recent surveys, this prevalence has been increasing over the last few decades for unknown reasons. As children with food allergies reach school age, the issue is becoming more common in schools. For that reason, schools are now required to be prepared to take responsibility for the safety of food-allergic students. This review discusses the common problems surrounding management of food allergies in the school setting along with reasonable recommendations for addressing those problems. The most important component of food allergy management is for the student to get an accurate diagnosis and to then discuss development of an anaphylaxis action plan with their health-care provider. Each school should insist that a copy of such a plan be provided for each student with food allergy and that epinephrine is readily available should a student have an anaphylactic reaction. In addition to epinephrine, it is essential that school personnel be properly trained to recognize and treat allergic reactions should they occur. Known deficiencies in school preparedness have been documented in previous literature, and consequently, both state and the federal government have begun to implement policies to help with school preparedness.

Differential effects of catecholamines on in vitro growth of pathogenic bacteria

NASA Technical Reports Server (NTRS)

Belay, Tesfaye; Sonnenfeld, Gerald

2002-01-01

Supplementation of minimal medium inoculated with bacterial cultures with norepinephrine, epinephrine, dopamine, or isoproterenol resulted in marked increases in growth compared to controls. Norepinephrine and dopamine had the greatest enhancing effects on growth of cultures of Pseudomonas aeruginosa and Klebsiella pneumoniae, while epinephrine and isoproterenol also enhanced growth to a lesser extent. The growth of Escherichia coli in the presence of norepinephrine was greater than growth in the presence of the three other neurochemicals used in the study. Growth of Staphylococcus aureus was also enhanced in the presence of norepinephrine, but not to the same degree as was the growth of gram negative bacteria. Addition of culture supernatants from E. coli cultures that had been grown in the presence of norepinephrine was able to enhance the growth of K. pneumoniae. Addition of the culture supernatant fluid culture from E. coli cultures that had been grown in the presence of norepinephrine did not enhance growth of P. aeruginosa or S. aureus. Culture supernatant fluids from bacteria other than E. coli grown in the presence of norepinephrine were not able to enhance the growth of any bacteria tested. The results suggest that catecholamines can enhance growth of pathogenic bacteria, which may contribute to development of pathogenesis; however, there is no uniform effect of catecholamines on bacterial growth.

The use of compound topical anesthetics: a review.

PubMed

Kravitz, Neal D

2007-10-01

The author reviewed the history of, federal regulations regarding, risks of and adverse drug reactions of five compound topical anesthetics: tetracaine, adrenaline/epinephrine and cocaine (TAC); lidocaine, adrenaline/epinephrine and tetracaine (LET); lidocaine, tetracaine and phenylephrine (TAC 20 percent Alternate); lidocaine, prilocaine and tetracaine (Profound); and lidocaine, prilocaine, tetracaine and phenylephrine with thickeners (Profound PET). The author reviewed clinical trials, case reports, descriptive articles, and U.S. Food and Drug Administration (FDA) regulations and recent public advisory warnings regarding the federal approval of and risks associated with the use of compound topical anesthetics. Compound topical anesthetics are neither FDA-regulated nor -unregulated. Some compounding pharmacies bypass the new FDA drug approval process, which is based on reliable scientific data and ensures that a marketed drug is safe, effective, properly manufactured and accurately labeled. Two deaths have been attributed to the lay use of compound topical anesthetics. In response, the FDA has announced the strengthening of its efforts against unapproved drug products. Compound topical anesthetics may be an effective alternative to local infiltration for some minimally invasive dental procedures; however, legitimate concerns exist in regard to their safety. Until they become federally regulated, compound topical anesthetics remain unapproved drug products whose benefits may not outweigh their risks for dental patients.

Non-pharmacological interventions during childbirth for pain relief, anxiety, and neuroendocrine stress parameters: A randomized controlled trial.

PubMed

Henrique, Angelita José; Gabrielloni, Maria Cristina; Rodney, Patricia; Barbieri, Márcia

2018-03-07

This study aimed to investigate the effect of warm shower hydrotherapy and perineal exercises with a ball on pain, anxiety, and neuroendocrine stress parameters during childbirth. This randomized controlled trial was conducted with 128 women during childbirth, admitted for hospital birth in São Paulo, Brazil, from June 2013 to February 2014. The participants were randomly assigned into one of the following intervention groups: received warm shower hydrotherapy (GA); performed perineal exercises with a ball (GB); and combined intervention group, which received warm shower hydrotherapy and perineal exercises with a ball (GC) (n = 39). Pre-and post-intervention parameters were evaluated using visual analogue scales for pain and anxiety, and salivary samples were collected for the stress hormones analysis. Pain, anxiety, and epinephrine release decreased in the group performing perineal exercises with a ball (GB). β-endorphin levels increased in this group (GB) after the intervention and showed significant difference in capacity to cause this effect (P = .007). However, no significant differences were observed in cortisol, epinephrine, and norepinephrine levels. Warm showers and perineal exercises could be considered as adjunct therapy for women suffering from pain, anxiety, and stress during childbirth. Clinical Trial Registry RBR-84xprt. © 2018 John Wiley & Sons Australia, Ltd.

Microfluidic resonant waveguide grating biosensor system for whole cell sensing

NASA Astrophysics Data System (ADS)

Zaytseva, Natalya; Miller, William; Goral, Vasily; Hepburn, Jerry; Fang, Ye

2011-04-01

We report on a fluidic resonant waveguide grating (RWG) biosensor system that enables medium throughput measurements of cellular responses under microfluidics in a 32-well format. Dynamic mass redistribution assays under microfluidics differentiate the cross-desensitization process between the β2-adrenoceptor agonist epinephrine and the adenylate cyclase activator forskolin mediated signaling. This system opens new possibility to study cellular processes that are otherwise difficult to achieve using conventional RWG configurations.

A MECHANISM OF THE GLYCOGENOLYTIC ACTION OF BACTERIAL ENDOTOXIN

PubMed Central

Sanford, Jay P.; Barnett, Jack A.; Gott, Cora

1960-01-01

These experiments have demonstrated that liver glycogen may rise or fall after endotoxin administration, depending upon the antecedent diet and that total adrenalectomy followed by corticosteroid replacement abolishes the glycogenolytic effect of sublethal doses of endotoxin. It is concluded that the derangements of carbohydrate metabolism observed following the administration of sublethal quantities of bacterial endotoxin represent, not a direct hepatotoxic effect of endotoxin, but rather the passive consequence of epinephrine release. PMID:13746229

Ocular Hypertension and Chronic Open-Angle Glaucoma in USAF Pilots and Navigators

DTIC Science & Technology

1974-12-01

nontreat- ment (close observation) of the preglaucoma category and treatment wit; epinephrine only of those classified glaucoma ha* been carried out now...concepts of glaucoma and glaucoma treatment versus the new "contemporary school" approach (differentiating ocular hypertension from glaucoma). This study...acute attack rather than the screening program. Onset ages for the secondary cases ranged from 28 to 53; 5 of these were secondary to uveitis , and

Factor XII (Hageman factor) is a missing link between stress and hypercoagulability and plays an important role in the pathophysiology of ischemic stroke.

PubMed

Eggers, Arnold E

2006-01-01

A new hypothesis is presented on the function of factor XII, which is postulated to be a "missing link" between acute stress and transient hypercoagulability. The implications of this idea are developed to show how chronic stress, which involves activation of hypertension and migraine as well as hypercoagulability, can cause of cerebrovascular disease. "Acute stress" is defined as "the normal short-term physiological response to the perception of major threats or demands". "Chronic stress" is "the abnormal ongoing physiological response to the continuing perception of unresolvable major threats or demands". The factor XII hypothesis is as follows: Acute stress includes release of epinephrine by the adrenal medulla. Epinephrine activates platelets by binding to alpha-2A adrenergic receptors. Activated platelets convert pre-bound factor XII to its active form, which then initiates the intrinsic coagulation cascade. This can be called the "activated platelet initiation pathway" for coagulation. Neither tissue factor nor pre-formed thrombin is required. Thrombosis proceeds to completion, but only a minute amount of thrombin is formed, and the process normally stops at this point. In people who lapse into a state of chronic stress, essential hypertension, which is also a manifestation of stress, synergizes with hypercoagulability: there is both a baseline rise in blood pressure and systemic platelet activation as well as superimposed labile rises of both. Upregulation of these two stress parameters is atherogenic: epinephrine-activated platelets stimulating thrombin formation interact with endothelial cells activated by angiotensin II to cause, first, smooth muscle cell proliferation, which is a histological hallmark of atherosclerosis, and, lastly, a symptomatic thrombotic occlusion-the stroke. The migraine symptoms which often accompany this process are a marker of chronic stress and ongoing pathophysiologic damage. Therapeutic predictions are made regarding novel ways of blocking stress-induced hypercoagulability and hypertension. Hypercoagulability could be targeted by monoclonal antibodies directed against the platelet-specific alpha-2 adrenergic receptor or the (putative) platelet receptor for Factor XII; hypertension could be treated with monoclonal antibodies directed against the beta-adrenergic receptor in the juxtaglomerular apparatus or by surgical denervation of the kidneys, either of which would decrease the renin release which helps drive the hypertension.

The effect of bedrest on adrenal function

NASA Technical Reports Server (NTRS)

Leach, C. S.; Hulley, S. B.; Rambaut, P. C.; Dietlein, L. F.

1973-01-01

Eight male subjects were subjected to continuous bedrest for 24-80 weeks for the purpose of studying metabolic responses. Three of the subjects did supine exercises daily during part of the study. Adrenal function was examined in relation to adrenal cortical and medullary excretions. The results reveal an increase in hydrocortisone throughout the test period, a decrease in norepinephrine and no change in epinephrine. These data suggest that exercise could decrease the severity of deconditioning caused by bedrest.

The Role of Hypothalamic Insulin and Dopamine in the Anorectic Effect of Cocaine and d-amphetamine

DTIC Science & Technology

1992-08-21

15: Figure 16: Figure 17: Figure 18: LIST OF FIGURES Chemical structure of cocaine Chemical structure of amphetamine Cocaine groups! Average...prevent hypotension (Hoffman, 1987). The chemical structure of amphetamine is shown in figure 2. General Aspects: The term amphetamine applies to a group...cormnunication, 1991). 26 Germany in the 1930’s, with c hemical structures resembling those of epinephrine and NE. Their effects are similar to those of

Projecting Medical Supply Requirements for a Highly Mobile Forward Resuscitative Surgery System

DTIC Science & Technology

1999-10-01

Sulfate Injection 0.5MG/ML 20ML Vial 6505013859409 Ephedrine Sulfate Injection 50MG/ML Ampoules 100S 6505012385634 Epinephrine Injection 1ML Syringe...Container 12S 6505010410558 Theopental Sodium Injection 500MG Vial 25S 6505012582004 Vecuronium Bromide Injection IMG/ML 10ML Vial 10S...Sterile 1GM Container 12S 6505012582004 Vecuronium Bromide Injection IMG/ML 10ML Vial 10S 6135009857845 Battery Nonrechargeable 1.5Volt Size AA 24S

Pharmacologic and Nonpharmacologic Approaches to the Treatment of Hypertension with Implications for the Clinical Nurse Specialist

DTIC Science & Technology

1988-01-01

Hypertension 6 14 that assist in regulation of smooth muscle contraction . This results in a lowered peripheral vascular resistance and 6 thus, a lowering of...the effect of epinephrine and also allows the sustained vascular smooth - muscle contraction caused by the catecholamines; this too, contributing to an...hypertension. These agents cause arteriolar dilatation by acting directly on vascular smooth muscle . They do this by interfering with the calcium gates

Reversible blindness associated with alcoholic ketoacidosis.

PubMed

Yanagawa, Youichi; Kiyozumi, Teturou; Hatanaka, Kousuke; Itoh, Toshitaka; Sakamoto, Toshihisa; Okada, Yoshiaki

2004-04-01

To report a case of reversible blindness associated with severe alcoholic ketoacidosis. Observational case report. A 44-year-old male presented with gradual bilateral blindness that developed within a 24-hour period. He suffered from ethanol-induced severe ketoacidosis and shock and was resuscitated with epinephrine and sodium bicarbonate. The treatment of acidosis led to a rapid resolution of the patient's blindness. It is important to understand the role of severe acidosis as the sole causative factor of reversible bilateral blindness.

[Hormone content of the blood plasma of rats after a flight on the Kosmos-1129 biosatellite].

PubMed

Tigranian, R A; Kalita, N F; Macho, L; Kvetnanský, R

1985-01-01

The concentration of ACTH, insulin, glucagon, glucose, epinephrine, norepinephrine, thyrotrophic hormone, thyroxine, and triiodothyronine was measured in plasma of the rats flown for 18.5 days on Cosmos-1129. As a result of the flight, the concentration of insulin, thyrotrophic hormone, and triiodothyronine increased and that of thyroxine decreased. It is suggested that the above changes have been induced by an acute stress associated with biosatellite reentry and touchdown.

Coping Flexibility: Influencing Appraisals of Stress

DTIC Science & Technology

1992-09-25

organism was exposed to fear- inducing stimuli (Cannon and de la Paz, 1911 ). The substance Wsympathin", later to be named epinephrine, was identified...coping repertoire must playa role in this process. Rigid application of problem-focused coping across controllable and uncontrollable situations may...cabbage :e a splice C a steak D a paper box .::. a fish 3. To stop severe bleeding A a razor blade B a lima bean C a light bulb D a shoe E

Time-dependent interventions

PubMed Central

Weil, Max Harry; Tang, Wanchun

2004-01-01

The contribution by Pepe and colleagues provides additional evidence that initial defibrillation is not necessarily the optimal intervention for victims of cardiac arrest and especially when cardiac arrest has been untreated for more than 3 min. Precordial compression therefore remains the mainstay of basic life support cardiopulmonary resuscitation after sudden death. It is increasingly apparent that neither epinephrine whether in conventional or high doses nor vasopressin improve ultimate survival. To the contrary, there is evidence favoring β1-adrenergic blockade. PMID:14975039

Comparison of ropivacaine and articaine with epinephrine for infiltration anaesthesia in dentistry - a randomized study.

PubMed

Krzemiński, T F; Gilowski, L; Wiench, R; Płocica, I; Kondzielnik, P; Sielańczyk, A

2011-08-01

To compare the efficacy, onset time and duration of maxillary infiltration anaesthesia with 0.5% plain ropivacaine or 4% articaine with epinephrine 1 : 100 000 and to determine their possible influence on cardiovascular parameters. Sixty volunteers received 1.8 mL of the anaesthetic for buccal infiltration anaesthesia of maxillary central and lateral incisors and canine teeth without caries, restorations or signs of pulpitis. The efficacy, onset time and duration of pulp anaesthesia were assessed with an electric pulp tester. The duration of numbness of the upper lip was also monitored. Blood pressure and heart rate were measured before and after administration of the solutions. The efficacy of anaesthesia of lateral and central incisors was 100% for both anaesthetics. There were insignificant differences in effectiveness of canine pulp anaesthesia. The mean onset time was significantly (P < 0.05) shorter for ropivacaine (2.22 min) when compared with articaine (4.08 min). The duration of action and soft tissue anaesthesia were also significantly (P < 0.05) longer for ropivacaine (79.2 and 264 min) when compared with articaine (63.7 and 195.2 min, respectively). Ropivacaine caused significant (P < 0.05) increases in blood pressure and heart rate. Ropivacaine (0.5%) achieved effective and long duration of uninflamed pulp and soft tissue anaesthesia. Ropivacaine could be useful for long-lasting operative procedures without the need for a vasoconstrictor. © 2011 International Endodontic Journal.

Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

PubMed

Chertoff, Jason; Khullar, Vikas; Burke, Lucas

2015-01-01

The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study.

PubMed

Sakhaeimanesh, Vahid; Khazaei, Saber; Kaviani, Naser; Saatchi, Masoud; Shafiei, Maryam; Khademi, Abbasali

2017-01-01

The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis. Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t , Mann-Whitney and Chi -square tests. The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups ( P =0.437) . Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis.

Acute effects of exercise on plasma catecholamines in sedentary and athletic women with normal and abnormal menses.

PubMed

Chin, N W; Chang, F E; Dodds, W G; Kim, M H; Malarkey, W B

1987-10-01

Norepinephrine plays a role in the regulation of luteinizing hormone secretion and may therefore be involved in the etiology of exercise-induced menstrual dysfunction. This study evaluated both intraexercise and postexercise responses of epinephrine, norepinephrine, and dopamine in sedentary women and women runners with normal and abnormal menstruation. Five eumenorrheic nonrunners and five eumenorrheic, four oligomenorrheic, and five amenorrheic runners were evaluated on 2 consecutive days. On day 1, the women cycled on a bicycle ergometer against an increasing work load until exhaustion, and on day 2, the women underwent a submaximal exercise regimen. Serial blood draws were taken at specified time intervals during intraexercise and postexercise periods on both days. The data collected during exercise for all groups showed that epinephrine and norepinephrine had a sixfold to sevenfold rise on day 1 and had a threefold rise on day 2. Dopamine increased twofold during both exercise protocols. On day 1 norepinephrine displayed a significantly higher percentage change from baseline to peak levels for oligomenorrheic and amenorrheic runners than for eumenorrheic runners and sedentary women. This latter finding is consistent with the hypothesis that periodic marked elevations in norepinephrine levels during maximal exercise may interfere with pulsatile luteinizing hormone release and hence may play a role in the occurrence of menstrual dysfunction in women runners.

Comparison of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure.

PubMed

Polat, Fazli; Tuncel, Altug; Balci, Melih; Aslan, Yilmaz; Sacan, Ozlem; Kisa, Cebrail; Kayali, Mustafa; Atan, Ali

2013-10-01

To compare the local anesthetic effects of tramadol hydrochloride with those of lidocaine in circumcision procedures. We also investigated the effect of child anxiety on pain level. A total of 70 children were included in this study. The children were randomized into 3 groups. Group 1 (n = 26) received lidocaine hydrochloride + epinephrine and they underwent circumcision using Ali's clamp(®). Group 2 (n = 35) received lidocaine hydrochloride + epinephrine and group 3 (n = 12) 5% tramadol. The last two groups underwent conventional circumcision. The mean anxiety score was 22.6. We did not find significant differences in terms of anxiety score among the groups (p = 0.761). When the pain scores of the groups during injection were compared, it was found that there were no significant differences. However, the pain score of the third group was significantly high when it was compared with the first and second group 2 and 10 min after injection. In the correlation analysis, we found a positive correlation between children's anxiety scores and the pain degree during injection (r = 0.373, p = 0.001). Tramadol may not provide effective local anesthesia in male circumcision. The child's anxiety before the circumcision seems to have a negative effect on pain level. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Platelet aggregation responses in clinically healthy adult llamas.

PubMed

Gilbert, Rosanne M; Bird, Karyn E; Kutzler, Michelle A

2009-03-01

Limited information exists regarding hemostasis in camelids despite the importance of platelet function testing in the accurate identification of platelet disorders. As further importation of llamas to North America is restricted, variability in breeding stock will continue to decrease, potentially leading to an increase in heritable bleeding disorders. The objective of this study was to measure platelet aggregation responses in clinically healthy llamas and provide baseline data to which abnormal platelet function may be compared in the future. Blood samples were collected from 39 healthy adult llamas, citrated, and centrifuged to produce platelet-rich plasma (PRP). Within 4 hours of the blood draw, 20 microL of each agonist reagent were added to 180 microL of PRP. Final concentrations of agonists were 2 x 10(-5) M ADP, 0.19 mg collagen/mL PRP, 1 x 10(-4) M epinephrine, and 500 microg arachidonic acid/mL PRP. Llama platelets were most responsive to ADP and collagen, with a maximum percent aggregation (mean+/-SD) of 71.3+/-18.6% and 55.8+/-19% and aggregation rates of 9.5+/-3.9 and 6.7+/-3.7 cm/min, respectively. Llama platelet aggregation in response to epinephrine and arachidonic acid was minimal to absent. This study is the first of its kind to establish baseline values for platelet aggregation in healthy adult llamas.

An evaluation of the histological effects of intra-articular methadone in the canine model.

PubMed

Jones, Timothy A; Hand, Walter R; Ports, Michael D; Unger, Daniel V; Herbert, Daniel; Pellegrini, Joseph E

2003-02-01

Methadone hydrochloride is an opiate that has pharmacodynamic and pharmacokinetic properties that suggest it may provide longer analgesia than morphine when administered via the intra-articular route. However, no studies to date have been conducted examining the effects of intra-articular methadone hydrochloride on local tissues. Therefore, the purpose of this study was to determine the histopathologic effects of intra-articular methadone hydrochloride on local tissues in the canine knee. Nine canines, 1 to 4 years old, weighing between 20 kg and 23 kg were used. All canines had their knees randomized to receive either bupivacaine, 0.5% with epinephrine 1:200,000 (4.5 mL), and 5 mg methadone hydrochloride (0.5 mL) for the study knee, or bupivacaine, 0.5% with epinephrine 1:200,000 (4.5 mL), and 0.5 mL normal saline for the control knee. Serum methadone hydrochloride levels were obtained on all canines at 6 and 24 hours. Canines were randomly assigned to 1 of 3 groups to be euthanized at either 24 hours, 14 days, or 28 days. Following euthanization and necropsy, synovial fluid levels and tissue samples were obtained and examined for histopathologic changes. Synovial fluid samples noted a few white blood cells at 24 hours and none at 14 and 28 days. Tissue samples showed no histopathologic changes, and serum concentration levels of methadone hydrochloride were negligible.

One-per-mil tumescent technique for upper extremity surgeries: broadening the indication.

PubMed

Prasetyono, Theddeus O H; Biben, Johannes A

2014-01-01

We studied the effect of 1:1,000,000 epinephrine concentration (1 per mil) to attain a bloodless operative field in hand and upper extremity surgery and to explore its effectiveness and safety profile. This retrospective observational study enrolled 45 consecutive patients with 63 operative fields consisting of various hand and upper extremity problems. One-per-mil solution was injected into the operative field with tumescent technique to create a bloodless operating field without tourniquet. The solution was formulated by adding a 1:1,000,000 concentration of epinephrine and 100 mg of lidocaine into saline solution to form 50 mL of tumescent solution. Observation was performed on the clarity of the operative field, which we described as totally bloodless, minimal bleeding, acceptable bleeding, or bloody. The volume of tumescent solution injected, duration of surgery, and surgical outcome were also reviewed. The tumescent technique with 1-per-mil solution achieved 29% totally bloodless, 48% minimal bleeding, 22% acceptable bleeding, and 2% bloody operative fields in cases that included burn contracture and congenital hand and upper extremity surgeries. One-per-mil tumescent solution created a clear operative field in hand and upper extremity surgery. It proved safe and effective for a wide range of indications. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Catecholaminergic effects of prolonged head-down bed rest

NASA Technical Reports Server (NTRS)

Goldstein, D. S.; Vernikos, J.; Holmes, C.; Convertino, V. A.

1995-01-01

Prolonged head-down bed rest (HDBR) provides a model for examining responses to chronic weightlessness in humans. Eight healthy volunteers underwent HDBR for 2 wk. Antecubital venous blood was sampled for plasma levels of catechols [norepinephrine (NE), epinephrine, dopamine, dihydroxyphenylalanine, dihydroxyphenylglycol, and dihydroxyphenylacetic acid] after supine rest on a control (C) day and after 4 h and 7 and 14 days of HDBR. Urine was collected after 2 h of supine rest during day C, 2 h before HDBR, and during the intervals 1-4, 4-24, 144-168 (day 7), and 312-336 h (day 14) of HDBR. All subjects had decreased plasma and blood volumes (mean 16%), atriopeptin levels (31%), and peripheral venous pressure (26%) after HDBR. NE excretion on day 14 of HDBR was decreased by 35% from that on day C, without further trends as HDBR continued, whereas plasma levels were only variably and nonsignificantly decreased. Excretion rates of dihydroxyphenylglycol and dihydroxyphenylalanine decreased slightly during HDBR; excretion rates of epinephrine, dopamine, and dihydroxyphenylacetic acid and plasma levels of catechols were unchanged. The results suggest that HDBR produces sustained inhibition of sympathoneural release, turnover, and synthesis of NE without affecting adrenomedullary secretion or renal dopamine production. Concurrent hypovolemia probably interferes with detection of sympathoinhibition by plasma levels of NE and other catechols in this setting. Sympathoinhibition, despite decreased blood volume, may help to explain orthostatic intolerance in astronauts returning from spaceflights.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

C-11 hydroxy ephedrine, introduced as the first clinically usable norepinephrine analogue, studies employing normal volunteers and patients with various cardiac disorders was found to valuable as a nonadreneric tracer. Simultaneously, animal studies been used to assess its use following ischemic injury in order to define neuronal damage. Current research focuses on the comparison of C-11 hydroxyephedrine with other neurotransmitters such as C-11 epinephrine and C-11 threohydroxyephedrine. Epinephrine is primarily stored in vesicles of the nerve terminal, while threo-hydroxyephedrine is only substrate to uptake I mechanism. Such a combination of radiotracers may allow the dissection of uptake I mechanism as wellmore » as vesicular storage. In parallel to the refinement of presynaptic tracers for the sympathetic nervous system, we are developing radiopharmaceuticals to delineate the adrenergic receptors in the heart. The combined evaluation of pre- and postsynaptic nerve function will improve our ability to identify abnormalides. We are currently developing a new radiosynthesis of the hydrophilic adrenergic receptor antagonist C-11 CGP-12177 which has been used by others for the visualization of adrenergic receptors in the heart. We are developing radiopharmaceuticals, for the delineation of presynaptic cholinergic nerve terminals. Derivatives of benzovesamicol have been labeled in our institution and are currently under investigation. The most promising agent is F-18 benzovesamicol (FEBOBV) which allows the visualization of parasympathetic nerve terminals in the canine heart as demonstrated by, preliminary PET data.« less

[Case of anaphylactic shock induced by an antibiotic after induction of anesthesia].

PubMed

Tanaka, Shinichiro; Satoh, Masaaki; Hirabayashi, Yoshihiro; Nunomiya, Shin; Seo, Norimasa

2006-10-01

We report a case of anaphylactic shock induced by an antibiotic administrated after induction. A 39-year-old man was scheduled for removal of right adrenal tumor. After insertion of an epidural catheter, anesthesia was induced with an intravenous bolus injection of fentanyl 100 microg, propofol 130 mg and vecuronium 6 mg. The trachea was intubated smoothly and anesthesia was maintained with sevoflurane. Sultamicillin tosilate was administrated intravenously. Soon, ephedrine 12 mg was given intravenously because his blood pressures decreased. However, his blood pressure did not recover, but fell down to 35/22 mmHg. He was turned to head-down position, and 100% oxygen was administrated. Following epinephrine 0.1 mg injection, his blood pressure increased to 80/40 mmHg. Epinephrine at 0.005-0.02 microg x kg(-1) x min(-1) was infused continuously to maintain his blood pressure. We found erhythemia on his face, shoulders and arms. Hydrocortisone sodium succinate and acetate Ringer's solution were administrated to treat his anaphylactic shock and the surgery was postponed. The blood samples indicated that this event was IgE-mediated anaphylactic reaction. From his past history, penicillin allergy was confirmed. The surgery was rescheduled and anesthesia was managed in the same way as previous one. Surgery was successfully performed using levofloxacin, which had been taken orally before induction of anesthesia.

α(1,3)-Fucosyltransferases FUT4 and FUT7 Control Murine Susceptibility to Thrombosis

PubMed Central

Wang, Huili; Morales-Levy, Maria; Rose, Jason; Mackey, Lantz C.; Bodary, Peter; Eitzman, Daniel; Homeister, Jonathon W.

2014-01-01

The α(1,3)-fucosyltransferases, types IV and VII (FUT4 and FUT7, respectively), are required for the synthesis of functional selectin-type leukocyte adhesion molecule ligands. The selectins and their ligands modulate leukocyte trafficking, and P-selectin and its ligand, P-selectin glycoprotein ligand-1, can modulate hemostasis and thrombosis. Regulation of thrombosis by FUT4 and/or FUT7 activity was examined in mouse models of carotid artery thrombosis and collagen/epinephrine-induced thromboembolism. Mice lacking both FUT4 and FUT7 (Fut−/− mice) had a shorter time to occlusive thrombus formation in the injured carotid artery and a higher mortality due to collagen/epinephrine-induced pulmonary thromboemboli. Mice lacking P-selectin or P-selectin glycoprotein ligand-1 did not have a prothrombotic phenotype. Whole blood platelet aggregation was enhanced, and plasma fibrinogen content, clot weight, and clot strength were increased in Fut−/− mice, and in vitro clot lysis was reduced compared with wild type. Fut4−/−, but not Fut7−/−, mice had increased pulmonary thromboembolism-induced mortality and decreased thromboemboli dissolution in vivo. These data show that FUT4 and FUT7 activity regulates thrombosis in a P-selectin– and P-selectin glycoprotein ligand-1–independent manner and suggest that FUT4 activity is important for thrombolysis. PMID:23562273

Erythrocyte plasma membrane-bound ERK1/2 activation promotes ICAM-4-mediated sickle red cell adhesion to endothelium.

PubMed

Zennadi, Rahima; Whalen, Erin J; Soderblom, Erik J; Alexander, Susan C; Thompson, J Will; Dubois, Laura G; Moseley, M Arthur; Telen, Marilyn J

2012-02-02

The core pathology of sickle cell disease (SCD) starts with the erythrocyte (RBC). Aberration in MAPK/ERK1/2 signaling, which can regulate cell adhesion, occurs in diverse pathologies. Because RBCs contain abundant ERK1/2, we predicted that ERK1/2 is functional in sickle (SS) RBCs and promotes adherence, a hallmark of SCD. ERK1/2 remained active in SS but not normal RBCs. β(2)-adrenergic receptor stimulation by epinephrine can enhance ERK1/2 activity only in SS RBCs via PKA- and tyrosine kinase p72(syk)-dependent pathways. ERK signaling is implicated in RBC ICAM-4 phosphorylation, promoting SS RBC adhesion to the endothelium. SS RBC adhesion and phosphorylation of both ERK and ICAM-4 all decreased with continued cell exposure to epinephrine, implying that activation of ICAM-4-mediated SS RBC adhesion is temporally associated with ERK1/2 activation. Furthermore, recombinant ERK2 phosphorylated α- and β-adducins and dematin at the ERK consensus motif. Cytoskeletal protein 4.1 also showed dynamic phosphorylation but not at the ERK consensus motif. These results demonstrate that ERK activation induces phosphorylation of cytoskeletal proteins and the adhesion molecule ICAM-4, promoting SS RBC adhesion to the endothelium. Thus, blocking RBC ERK1/2 activation, such as that promoted by catecholamine stress hormones, could ameliorate SCD pathophysiology.

Types of aggressiveness and catecholamine response in essential hypertensives and healthy controls.

PubMed

Netter, P; Neuhäuser-Metternich, S

1991-01-01

Relationships between plasma catecholamine responses, and levels and types of aggression in hyper- and normotensives were investigated by analyses of data obtained in a large psychophysiological experiment on 97 hypertensives (EH) and 98 normotensives (CO) each. Subjects were divided according to levels (high vs low) and types (repressed vs manifest) of aggressiveness according to self rating questionnaire scores. Their plasma catecholamine responses to defined stressors indicating sympathetic arousability were compared by four factor analyses of covariance adjusting for age. Repressed aggression was significantly more frequent among male EH, whereas manifest aggression was significantly more frequent among the male COs. High as compared to low hostility was associated with significantly elevated values of plasma epinephrine in EH but not in CO. The immediate norepinephrine stress response was blunted but showed a delayed increase during the subsequent period of rest in high aggressives of both the EH and CO group, a pattern particularly pronounced in repressed aggressive hypertensives. Neither cardiovascular reactions nor speed of performance were observed to be substantially different in subjects of repressed and of manifest hostility. It was concluded that aggression in general is characterized by a delayed norepinephrine stress response and that an association with high epinephrine is typical for aggressiveness in hypertensives. Repressed hostility, however, does not produce a sympathomedullary pattern substantially different from that of manifest aggression thus casting doubt on the physiological significance of repression claimed by Alexander.

Hormonal regulation of hepatic glycogenolysis in the carp, Cyprinus carpio

DOE Office of Scientific and Technical Information (OSTI.GOV)

Janssens, P.A.; Lowrey, P.

1987-04-01

Carp (Cyprinus carpio) liver maintained normal glycogen content and enzyme complement for several days in organ culture. Epinephrine-stimulated glycogenolysis, phosphorylase activation, and cyclic AMP (cAMP) accumulation in a concentration-dependent manner with EC/sub 50/s of 100, 100, and 500 nM, respectively. These actions were blocked by the ..beta..-adrenergic antagonist, propranolol, but not by the ..cap alpha..-adrenergic antagonist phentolamine. Glycogenolysis and tissue cAMP were uninfluenced by 10/sup -6/ M arginine vasotocin, arginine vasopressin, lysine vasotocin, lysine vasopressin, mesotocin, or oxytocin, but were slightly increased by 10/sup -5/ M isotocin and slightly decreased by 10/sup -6/ M angiotensin II. (/sup 125/I)-iodocyanopindolol (ICP), amore » ..beta..-adrenergic ligand, bound to isolated carp liver membranes with a K/sub D/ of 83 pM. Maximum binding of 45 fmol/mg protein was at 600 pM. Propranolol, isoprenaline, epinephrine, phenylephrine, norepinephrine, and phenoxybenzamine displaced ICP with K/sub D/s of 100 nM, 2, 20, 20, 60, and 200 ..mu..M, respectively. The ..cap alpha..-adrenergic antagonists, yohimbine and prazosin, showed no specific binding. These data provide evidence that catecholamines act via ..beta..-adrenergic receptors in carp liver and that ..cap alpha..-adrenergic receptors are not present. Vasoactive peptides play no significant role in regulation of carp liver glycogenolysis.« less