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Rev. bras. cir. cardiovasc ; 34(4): 444-450, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020503


Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Arrhythmias, Cardiac/etiology , Postoperative Complications/etiology , Coronary Artery Disease/surgery , Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass/adverse effects , Opioid-Related Disorders/complications , Arrhythmias, Cardiac/epidemiology , Postoperative Complications/epidemiology , Blood Pressure , Epinephrine/adverse effects , Central Venous Pressure , Heart Rate , Intensive Care Units
Evid. actual. práct. ambul ; 22(1): e001077, abr. 2019. tab.
Article in Spanish | LILACS | ID: biblio-1015125


La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)

Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)

Humans , Male , Female , Infant, Newborn , Infant , Bronchodilator Agents/administration & dosage , Bronchiolitis/drug therapy , Epinephrine/administration & dosage , Albuterol/administration & dosage , Respiratory Tract Infections/drug therapy , Bronchodilator Agents/adverse effects , Bronchodilator Agents/therapeutic use , Bronchiolitis/diagnosis , Epinephrine/adverse effects , Respiratory Sounds/diagnosis , Cough/prevention & control , Albuterol/adverse effects , Albuterol/therapeutic use , Fever/prevention & control
Rev. bras. anestesiol ; 66(1): 63-71, Jan.-Feb. 2016. graf
Article in Portuguese | LILACS | ID: lil-773483


BACKGROUND AND OBJECTIVES: Review of various techniques for digital blocks with local anesthetic, with or without epinephrine. CONTENTS: Description of various procedures and comparison of results reported in the literature, mainly on latency and quality of anesthesia, details on vasoconstrictor effect of epinephrine, intraoperative bleeding, necessity of tourniquet use, duration of anesthesia and postoperative analgesia, blood flow and digital SpO2 behavior, local and systemic complications, and also approaches and drugs to be used in certain situations of ischemia. CONCLUSIONS: The advantages of adding epinephrine to the anesthetic solution are minor when compared to the risks of the procedure, and it seems dangerous to use a vasoconstrictor in the fingers, unless the safety of the technique and the possibility of discarding the tourniquet are definitely proven.

JUSTIFICATIVA E OBJETIVOS: Revisão das diversas técnicas para bloqueios em dedos de mãos, com anestésico local associado ou não à epinefrina. CONTEÚDO: São descritos os procedimentos usados e comparados os resultados obtidos na literatura, principalmente em relação a: latência e qualidade da anestesia, detalhes sobre o efeito vasoconstritor da epinefrina, sangramento intraoperatório, necessidade ou não do uso de torniquete, duração da anestesia e da analgesia pós-operatórias, comportamento do fluxo arterial e da SpO2 digitais, complicações locais e sistêmicas e, ainda, condutas e medicamentos a serem usados em determinadas situações de isquemia. CONCLUSÕES: As vantagens da inclusão de epinefrina na solução anestésica são de pouca importância quando comparadas aos riscos do procedimento e parece perigoso usar o vasoconstritor em dedos de mão, a não ser que fiquem definitivamente comprovadas a inocuidade da técnica e a possibilidade do descarte do torniquete.

Humans , Epinephrine/administration & dosage , Anesthetics, Local/administration & dosage , Nerve Block/methods , Tourniquets/statistics & numerical data , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/adverse effects , Epinephrine/adverse effects , Blood Loss, Surgical , Fingers , Anesthetics, Local/adverse effects , Nerve Block/adverse effects
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.865-885.
Monography in Portuguese | LILACS | ID: biblio-971573
Acta Medica Iranica. 2013; 51 (8): 537-542
in English | IMEMR | ID: emr-142882


The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study. All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2 +/- 10.4, 74.8 +/- 14.4 kg and 164.5 +/- 8 cm respectively. Twelve patients [37.5%] were diagnosed with systemic hypertension and 10 patients with diabetes [31.2%]. The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable [P=0.044]. The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes.

Humans , Male , Female , Anesthetics, Local/adverse effects , Epinephrine/adverse effects , Myocardial Ischemia/surgery , Myocardial Ischemia/physiopathology , Coronary Angiography , Electrocardiography , Preoperative Care
Clinics ; 65(10): 975-978, 2010. ilus, tab
Article in English | LILACS | ID: lil-565980


OBJECTIVE: The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2 percent mepivacaine with adrenaline 1100,000) and (2) correlate those parameters with the patients' anxiety levels. METHOD: This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. RESULTS: Thirty-seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. CONCLUSION: The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used.

Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Anesthesia, Dental/adverse effects , Anesthesia, Local/adverse effects , Blood Glucose/analysis , Blood Pressure/drug effects , Dental Anxiety/metabolism , Vasoconstrictor Agents/adverse effects , Blood Pressure/physiology , Epinephrine/adverse effects , Hemodynamics/drug effects , Hemodynamics/physiology , Mepivacaine/adverse effects
Arq. bras. cardiol ; 93(5): 430-472, nov. 2009. graf, tab
Article in English, Spanish, Portuguese | LILACS | ID: lil-536212


FUNDAMENTO: Os efeitos da anestesia local em odontologia com lidocaína e epinefrina, sobre parâmetros cardiovasculares de gestantes portadoras de valvopatias e seus conceptos, não estão esclarecidos. OBJETIVO: Avaliar e analisar parâmetros da cardiotocografia, de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática, quando submetida à anestesia local com 1,8 ml de lidocaína 2 por cento sem vasoconstritor e com epinefrina 1:100.000, durante procedimento odontológico restaurador. MÉTODOS: Realizamos monitorização ambulatorial da pressão arterial, eletrocardiografia ambulatorial materna e cardiotocografia de 31 portadoras de cardiopatia reumática, entre a 28ª e 37ª semana de gestação, divididas em dois grupos conforme presença ou não do vasoconstritor RESULTADOS: Demonstrou-se redução significativa dos valores de frequência cardíaca materna nos dois grupos, durante o procedimento, quando comparado aos demais períodos (p < 0,001). Houve ocorrência de arritmia cardíaca em 9 (29,0 por cento) pacientes, das quais 7 (41,8 por cento) pertencentes ao grupo de 17 gestantes que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos períodos ou grupos (p > 0,05). O mesmo ocorreu (p > 0,05) com número de contrações uterinas, nível e variabilidade da linha de base e número de acelerações da frequência cardíaca fetal. CONCLUSÃO: O uso de 1,8 ml de lidocaína 2 por cento associado à adrenalina mostrou-se seguro e eficaz em procedimento odontológico restaurador durante a gestação de mulheres com cardiopatia valvar reumática.

BACKGROUND: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES: To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2 percent with or without epinephrine 1:100,000 during restorative dental treatment. METHODS: Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS: A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0 percent) patients, of which seven (41.8 percent) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION: The use of 1.8mL of lidocaine 2 percent in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.

FUNDAMENTO: Los efectos de la anestesia local en odontología con lidocaína y epinefrina, sobre los parámetros cardiovasculares de gestantes portadoras de valvulopatías y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parámetros de la cardiotocografía, de la presión arterial y electrocardiográficos de la gestante portadora de enfermedad valvular reumática, al someterse a anestesia local con 1,8 ml de lidocaína 2 por ciento sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontológico restaurador. MÉTODOS: Realizamos monitoreo ambulatorio de la presión arterial, electrocardiografía ambulatoria materna y cardiotocografía de 31 portadoras de cardiopatía reumática, entre la 28ª y la 37ª semana de gestación, divididas en dos grupos según la presencia o no del vasoconstrictor. RESULTADOS: Se observó reducción significativa de los valores de frecuencia cardíaca materna en los dos grupos, durante el procedimiento, al compararlo con los demás períodos (p < 0,001). Se registró ocurrencia de arritmia cardíaca en 9 (29,0 por ciento) pacientes, de las cuales 7 (41,8 por ciento) pertenecían al grupo de 17 gestantes que recibió anestesia con adrenalina. La presión arterial materna no presentó diferencia al comparar períodos o grupos (p > 0,05). Lo mismo ocurrió (p > 0,05) con el número de contracciones uterinas, nivel de variabilidad de la línea de base y número de aceleraciones de la frecuencia cardíaca fetal. CONCLUSIÓN: El uso de 1,8 ml de lidocaína 2 por ciento asociado a la adrenalina se mostró seguro y eficaz en procedimiento odontológico restaurador durante la gestación de mujeres con cardiopatía valvular reumática.

Adolescent , Adult , Female , Humans , Pregnancy , Young Adult , Anesthesia, Dental/adverse effects , Anesthetics, Local/adverse effects , Epinephrine/adverse effects , Lidocaine/adverse effects , Pregnancy Complications/physiopathology , Rheumatic Heart Disease/physiopathology , Analysis of Variance , Anesthetics, Combined/administration & dosage , Anesthetics, Combined/adverse effects , Anesthetics, Local/administration & dosage , Arrhythmias, Cardiac/chemically induced , Blood Pressure/drug effects , Cardiotocography , Epinephrine/administration & dosage , Gestational Age , Heart Rate, Fetal/drug effects , Lidocaine/administration & dosage , Monitoring, Ambulatory/methods , Statistics, Nonparametric , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/adverse effects , Young Adult
Clinics ; 64(3): 177-182, 2009. graf, tab
Article in English | LILACS | ID: lil-509436


OBJECTIVES: This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine. METHODS: This randomized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brazil). Patients were separated into two groups with the help of an aleatory number table: 2 percent plain lidocaine (PL, n= 31) and 2 percent lidocaine with epinephrine (1:100,000) (LE, n= 28). Blood pressure, heart rate, oxygenation and electrocardiogram data were all recorded throughout the procedure. State and trait anxiety levels were measured. RESULTS: Fifty-nine patients were selected for the LE group (n=28), with an average age of 40.3 ± 10.9, or for the PL group (n=31), age 42.2 ± 10.3. No differences were shown in blood pressure, heart rate and pulse oximetry values before, during and after local anesthesia injection between the two groups. State and trait anxiety levels were not different. Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment. Complaints of pain during the dental procedure were more frequent within the PL group, which received a higher amount of local anesthesia. CONCLUSION: Lidocaine with epinephrine (1:100,000) provided effective local anesthesia. This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases.

Adolescent , Adult , Aged , Humans , Middle Aged , Young Adult , Anesthesia, Dental/methods , Anesthetics, Local/administration & dosage , Epinephrine/administration & dosage , Heart Valve Diseases , Lidocaine/administration & dosage , Vasoconstrictor Agents/administration & dosage , Anesthesia, Dental/adverse effects , Anesthetics, Local/adverse effects , Blood Pressure/drug effects , Dental Care for Chronically Ill/methods , Electrocardiography/drug effects , Epinephrine/adverse effects , Heart Rate/drug effects , Lidocaine/adverse effects , Oxygen/blood , Vasoconstrictor Agents/adverse effects , Young Adult
Arch. venez. farmacol. ter ; 27(2): 129-131, 2008. graf
Article in Spanish | LILACS | ID: lil-517104


El extracto acuoso de las hojas de Bauhinia megalandra ha sido muy empleado en Venezuela en el tratamiento empírico de la diabetes mellitus. En el presente trabajo se estudió el efecto del extracto acuoso de B. megalandra sobre la glucogenolísis hepática estimulada por adrenalina o dibutiril AMPc. La administración oral del extracto de la planta, a ratas alimentadas, disminuyó de una manera estadísticamente significativa el incremento de la glicemia promovido por la adrenalina. De igual manera, rebanadas de hígado de ratas alimentadas incubadas en presencia del extracto de B. megalandra produjeron menos glucosa en respuesta a la adrenalina o al dibutiril AMPc que los controles. Estos resultados indican una disminución de la glucogenolísis hepática por efecto del extracto acuoso de hojas de B. megalandra, probablemente por inhibición de la enzima glucosa-6-fosfatasa.

Animals , Rats , Bucladesine/administration & dosage , Bucladesine/therapeutic use , Diabetes Mellitus , Epinephrine/adverse effects , /adverse effects
Arq. bras. cardiol ; 88(5): 545-551, maio 2007. tab, graf
Article in Portuguese | LILACS | ID: lil-453045


FUNDAMENTO: A literatura é controversa no que se refere ao uso de vasoconstritores para anestesia local em cardiopatas, havendo preocupação com a indução de descompensação cardíaca. OBJETIVO: Avaliar parâmetros eletrocardiográficos e de pressão arterial durante procedimento odontológico restaurador sob anestesia local com e sem vasoconstritor em portadores de doença arterial coronária. MÉTODOS: Neste estudo foram avaliados 62 pacientes. As idades variaram de 39 a 80 anos (média de 58,7 + 8,8) anos, sendo 51 pacientes (82,3 por cento) do sexo masculino. Do total de pacientes, 30 foram randomizados para receber anestesia com lidocaína 2 por cento com adrenalina (grupo LCA) e os demais para lidocaína 2 por cento sem vasoconstritor (grupo LSA). Todos foram submetidos a monitorização ambulatorial da pressão arterial e eletrocardiografia dinâmica por 24 horas. Foram considerados três períodos: 1) basal (registros obtidos durante os 60 minutos que antecederam o procedimento); 2) procedimento (registros obtidos desde o início da anestesia até o final do procedimento) e 3) das 24 horas. RESULTADOS: Houve elevação da pressão arterial do período basal para o procedimento nos dois grupos quando analisados separadamente; quando confrontados, não apresentaram diferença entre si. A freqüência cardíaca não se alterou nos dois grupos. Depressão do segmento ST > 1 mm não ocorreu durante os períodos basal e procedimento. Arritmias em número superior a 10 por hora estiveram presentes durante o procedimento em sete pacientes (12,5 por cento), sendo quatro (13,8 por cento) do grupo que recebeu anestesia sem adrenalina e três (11,1 por cento) do grupo com adrenalina. CONCLUSÃO: Não houve diferença em relação a comportamento da pressão arterial, freqüência cardíaca, evidência de isquemia e arritmias entre os grupos. O uso de vasoconstritor mostrou-se seguro dentro dos limites do estudo.

BACKGROUND: The use of vasoconstrictors for local anesthesia in patients with coronary heart disease is controversial in the literature, and there is concern regarding risk of cardiac decompensation. OBJECTIVE: To evaluate electrocardiographic and blood pressure parameters during restorative dental procedure under local anesthesia with and without a vasoconstrictor in patients with coronary artery disease. METHODS: Sixty-two patients were included in the study, ages ranging from 39 to 80 (mean 58.7 ± 8.8), 51 (83.2 percent) of whom were male. Thirty patients were randomly assigned to receive 2 percent lidocaine with epinephrine (epinephrine group), and the remaining patients, 2 percent lidocaine without epinephrine (non-epinephrine group) for local anesthesia. All patients underwent 24-hour ambulatory blood pressure monitoring and dynamic electrocardiography. Three periods were considered in the study: 1) baseline - recordings obtained during the 60 minutes prior to the procedure; 2) procedure - recordings obtained from the beginning of anesthesia to the end of the procedure and 3) 24 hours. RESULTS: There was an increase in blood pressure in both groups during the procedure, compared with baseline values; but when the two groups were compared no significant difference was detected between them. Heart rate remained unchanged in both groups. No ST-segment depression > 1 mm occurred either at baseline or during the procedure. Seven patients (12.5 percent) experienced more than ten arrhythmia episodes per hour during the procedure, four (13.8 percent) in the non-epinephrine group and three (11.1 percent) in the epinephrine group. CONCLUSION: No difference was observed in blood pressure, heart rate, or evidence of ischemia and arrhythmias in either group. The use of vasoconstrictor has proved to be safe within the range of the present study.

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anesthesia, Dental/methods , Anesthetics, Local/administration & dosage , Coronary Artery Disease , Dental Care for Chronically Ill/methods , Epinephrine/administration & dosage , Lidocaine/administration & dosage , Vasoconstrictor Agents/administration & dosage , Anesthesia, Dental/adverse effects , Anesthetics, Local/adverse effects , Blood Pressure/drug effects , Electrocardiography , Epinephrine/adverse effects , Lidocaine/adverse effects , Vasoconstrictor Agents/adverse effects
DRJ-Dental Research Journal. 2006; 3 (1): 4-8
in English | IMEMR | ID: emr-76423


Lidocaine plus epinephrine is the most common anesthetic drug used in dentistry which has important cardiovascular side-effects like increase in blood pressure and cardiac arrhythmia. The goal of this study was to evaluate cardiovascular effects of one cartridge of 2% lidocaine + 1:80000 epinephrine. 60 Cases without any systemic diseases who had been admitted for right and lower molar tooth extraction were studied. For all of them, inferior alveolar nerve was blocked with one cartridge of%2 lidocaine + 1:80000 epinephrine. Blood pressure and pulse rate were measured with Omron digital sphigmomanometer [model M4] and recorded in 5 stages [At the admit time until 10 minutes after injection], and compared with together. The findings of our study showed that injection of one Cartridge of 2% lidocaine + 1:80000 epinephrine has negligible effects on blood pressure and pulse rate. Because of the minimum cardiovascular effects of one cartridge of%2 lidocaine + 1:80000 epinephrine in healthy cases, it seems to be safe for patients with mild cardiovascular disease

Humans , Lidocaine/adverse effects , Lidocaine , Epinephrine/administration & dosage , Epinephrine/adverse effects , Epinephrine , Blood Pressure/drug effects , Heart Rate/drug effects , Oral Surgical Procedures , Nerve Block , Anesthesia, Dental
Journal of Qazvin University of Medical Sciences and Health Services [The]. 2006; 9 (4): 25-29
in Persian | IMEMR | ID: emr-78143


Synthetic drugs, although very effective, have their own side effects. Recently, herbal plants have received more attention to avoid the unpleasant effects of synthetic agents. To investigate the effects of garlic aqueous extract on contraction power of isolated atrium from male rats following administration of adrenalin. Male rats [Spirague Dawley, Albino, 200-250 gr] were divided into 7 groups as follows: Control, adrenalin, garlic extract [10 mg/kg, 20 mg/kg, and 40mg/kg], Propranolol and Propranolol plus garlic extract at a single concentration of 40 mg/kg. Later the contraction power was recorded using a physiograph set. Garlic extract at all three concentrations used in our study caused a reduction of atrial contraction power in adrenalin group. When the degree of contraction power reduction was compared between garlic extract [40mg/kg] and garlic extract plus Propranolol groups, no statistically significant difference found. Atrial contraction power decreased in presence of garlic aqueous extract and the degree of reduction was significant in both low and high doses, statistically

Animals, Laboratory , Heart Atria/drug effects , Rats , Epinephrine/pharmacology , Epinephrine/adverse effects
J. pediatr. (Rio J.) ; 81(3): 193-197, maio-jun. 2005. tab
Article in Portuguese | LILACS | ID: lil-406671


OBJETIVO: Apresentar evidências sobre a segurança da nebulização com 3 a 5 ml de adrenalina (1:1000) no tratamento das crianças com obstrução inflamatória aguda das vias aéreas. FONTES DE DADOS: Uma busca eletrônica foi feita, utilizando-se, principalmente, o banco de dados do MEDLINE (janeiro de 1949 a julho de 2004). Os critérios de inclusão do estudo para esta revisão foram: 1) ensaio clínico randomizado; 2) pacientes (até 12 anos) com diagnós tico de bronquiolite ou laringotraqueobronquite; 3) uso de adrenalina (1:1000) através de nebulização. Os principais dados extraídos dos ensaios dizem respeito a doses de adrenalina e seus efeitos sobre a freqüência cardíaca e a pressão arterial sistêmica, bem como outros efeitos colaterais. SíNTESE DOS DADOS: Sete ensaios clínicos, com um total de 238 pacientes, foram incluídos para esta revisão. Dos cinco ensaios clínicos nos quais a maior dose (> 3 ml) de adrenalina foi usada, dois demonstraram aumento significativo de freqüência cardíaca. O aumento médio de freqüência cardíaca variou de sete a 21 batimentos por minuto, até 60 minutos após o tratamento. A maior incidência de palidez foi observada em um ensaio clínico com 21 crianças tratadas com 3 ml de adrenalina através de nebulização (47,6 por cento no grupo de adrenalina versus 14,3 por cento no grupo de salbutamol, 30 minutos após o tratamento). Não foram observados, em dois ensaios clínicos, efeitos significativos em nebulização com adrenalina (4 e 5 ml) na pressão arterial sistêmica. CONCLUSAO: As evidências mostram que nebulização com 3 a 5 ml de adrenalina (1:1000) é uma terapia segura, com poucos efeitos colaterais, em crianças com obstrução inflamatória aguda das vias aéreas.

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Bronchiolitis/drug therapy , Bronchodilator Agents/administration & dosage , Epinephrine/administration & dosage , Laryngitis/drug therapy , Tracheitis/drug therapy , Acute Disease , Administration, Inhalation , Blood Pressure/drug effects , Bronchodilator Agents/adverse effects , Evidence-Based Medicine , Epinephrine/adverse effects , Heart Rate/drug effects , Randomized Controlled Trials as Topic
Indian Heart J ; 2005 May-Jun; 57(3): 261-4
Article in English | IMSEAR | ID: sea-6136


Inadvertent and accidental epinephrine overdose might result in potentially lethal complications. We present a case of acute epinephrine toxicity resulting in acute myocardial ischemia in a young boy with combined variable immunodeficiency syndrome who developed severe allergic reaction to intravenous immunoglobulin, and was subsequently given epinephrine by mistake intravenously rather than subcutaneously. He developed significant ischemic changes in standard 12-lead electrocardiogram, transiently raised cardiac enzymes, reduced left ventricular systolic function, pulmonary edema and pulmonary hemorrhage. It is suggested that special precautionary measures should be taken regarding the dose and the route while administering epinephrine to avoid mishaps.

Acute Disease , Adolescent , Dose-Response Relationship, Drug , Electrocardiography , Epinephrine/adverse effects , Follow-Up Studies , Humans , Hypersensitivity/drug therapy , Immunoglobulins, Intravenous/adverse effects , Infusions, Intravenous , Male , Medication Errors , Myocardial Ischemia/chemically induced , Risk Assessment , Severe Combined Immunodeficiency/diagnosis , Treatment Outcome
Assiut Medical Journal. 2005; 29 (3): 247-254
in English | IMEMR | ID: emr-70005


Supplementation of local epinephrine with anesthetic has a number of advantages. it prolongs the effect of anesthetics, reduces its amount required and speeds surgery by decreased bleeding into operative field. However, epinephrine has significant side effects. Increased end-tidal carbon dioxide concentration [ETCO2] has been reported if epinephrine at a concentration of 1 in 200,000 is injected into the nasal mucosa of patients undergoing general anesthesia for nasal surgery. Two concentrations of epinephrine were compared to determine the concentration effect on homodynamic and ETCO2 in pediatric patients undergoing cleft palate surgery Design: Prospective, randomized, single-blind clinical trial. Participants: Twenty four pediatric patients, aged 1 to 4 years undergoing cleft palate repair with general anesthesia were included in the study. To determine the epinephrine concentration effect on ETCO2 and hemodynamics in patients who received injections, in the hard palate, 3-3 ml mL of 1% lidocaine containing two concentrations of epinephrine [1:200,000, or 1:400,000] determined by randomization. Following local infiltration injection as mean values between 62 and 71 mmHg were maintained consistently throughout surgery. ETCO2 was transiently increased in both groups at 5 and 15 min after surgical incision, with significant difference between the two groups, P < 0.05 only at 15 min after incision. Surgeons did not complain about increase bleeding in the operative field in both groups. Amount of blood loss in group 1 is 71.25 +/- 15.49 ml compared with 72.25 +/- 13.53 ml in group II [P

Humans , Male , Female , Anesthesia, General , Epinephrine/adverse effects , Heterotrophic Processes , Carbon Dioxide , Tachycardia , Child , Lidocaine
Iranian Journal of Otorhinolaryngology. 2005; 17 (2): 101-106
in Persian | IMEMR | ID: emr-71044


Epinephrine usages in septoplasty and Septorhinoplasty have less hemorrhage during operation and blood loss field rule. But under general anesthesia with halothane usage of solutions, epinephrine will be with some risk. The question is which concentrations of epinephrine will be more efficacious and have less complication. This study was arranged as a clinical trial on 80 patients equally divided in four groups. In group 1 we used solution of epinephrine 1/100000 in group 2, solution of epinephrine 1/100000 with normal saline was used. In group 3 we used solution of epinephrine 1/200000 with Lidocaine 1% at last, solution of epinephrine 1/200000 with normal saline was used in the 4th group. Each of the groups included 20 patients who underwent septoplasty or Septorhinoplasty under general anesthesia with halothane. We monitored changes of systolic and diastolic blood pressures, pulse rates, volume of blood loss and any finding about dangerous dysrrhythmias such as ventricular arrhythmia. The mean percent of changes for systolic blood pressure was measured 8.46 +/- 4.59, this percent for diastolic blood pressure was measured as 10.55 +/- 5.89, and for pulse rates the mean percent of changes evaluated 7.85 +/- 4.61. In all of the groups, the percents were evaluated as less than 15% that were clinically acceptable. The mean volume of blood loss was evaluated as 73.13 +/- 30.02 milliliters. The differences were not statistically significant among the four groups. In the group 1, one case experienced an episode of ventricular tachycardia and in the second group one patient had ventricular tachycardia. Another patient showed an episode of ventricular fibrillation. Despite no statistically significant difference between group using solutions of epinephrine 1/100000 and solutions of epinephrine 1/200000 about mean percents of changes in systolic blood pressures, pulse rates and volume of blood losing, the higher concentrations of epinephrine 1/100000 raised the risk of dangerous ventricular arrhythmias, so this concentration is not recommended

Humans , Epinephrine/adverse effects , Rhinoplasty , Anesthesia, General , Halothane , Hemorrhage , Arrhythmias, Cardiac/chemically induced , Clinical Trials as Topic
Risafa Medical Journal. 2004; 1 (1): 92
in English, Arabic | IMEMR | ID: emr-68289
Arq. bras. med. vet. zootec ; 52(5): 444-6, out. 2000. tab
Article in Portuguese | LILACS | ID: lil-285596


In order to study the effects of different local anaesthetics with and without vasoconstritor (epinefrine), 20 adult crossbred cows were used. The following treatments were carried out: T1 - control (bidistilled water); T2 - chloridrate of lidocaine (20 mg/ml) with epinephrine (0.005 mg/ml); T3 - chloridrate of lidocaine (20 mg/ml) with epinephrine (0.02 mg/ml); T4 - chloridrate of lidocaine (20 mg/ml) with epinephrine (0.05 mg/ml); T5 - chloridrate of lidocaine(20 mg/ml); T6 - chloridrate of procaine (22 mg/ml) with epinefrine (0.02 mg/ml); T7 - chloridrate of procaine (22 mg/ml). The different solutions were injected, at the same time, into the subcutaneous space of the medial chest line, 10cm apart, of all cows. Observation at the infiltration sites was made 72 hours later, for the presence or not of tissue reaction, as well as lesion degrees. No differences were found among T1, T5, T6, and T7 , which did not cause tissue reaction. On the other hand, lower lesion tissue degrees were found in cows treated with T2 as compared to T3 and T4. It can be concluded that the use of both local anaesthetics alone or chloridrate of procaine with epinefrine are harmless to the skin while chloridrate of lidocaine associated with any concentration of vasoconstritor may give rise to tissue lesions in cattle

Animals , Female , Cattle , Anesthesia, Local , Epinephrine/adverse effects , Lidocaine , Vasoconstrictor Agents/adverse effects , Statistics, Nonparametric