Document Detail

The efficacy of epinephrine or vasopressin for resuscitation during epidural anesthesia.
MedLine Citation:
PMID:  11524349     Owner:  NLM     Status:  MEDLINE    
Cardiopulmonary resuscitation (CPR) during epidural anesthesia is considered difficult because of diminished coronary perfusion pressure. The efficacy of epinephrine and vasopressin in this setting is unknown. Therefore, we designed this study to assess the effects of epinephrine versus vasopressin on coronary perfusion pressure in a porcine model with and without epidural anesthesia and subsequent cardiac arrest. Thirty minutes before induction of cardiac arrest, 16 pigs received epidural anesthesia with bupivacaine while another 12 pigs received only saline administration epidurally. After 1 min of untreated ventricular fibrillation, followed by 3 min of basic life-support CPR, Epidural Animals and Control Animals randomly received every 5 min either epinephrine (45, 45, and 200 microg/kg) or vasopressin (0.4, 0.4, and 0.8 U/kg). During basic life-support CPR, mean +/- SEM coronary perfusion pressure was significantly lower after epidural bupivacaine than after epidural saline (13 +/- 1 vs 24 +/- 2 mm Hg, P < 0.05). Ninety seconds after the first drug administration, epinephrine increased coronary perfusion pressure significantly less than vasopressin in control animals without epidural block (42 +/- 2 vs 57 +/- 5 mm Hg, P < 0.05), but comparably to vasopressin after epidural block (45 +/- 4 vs 48 +/- 6 mm Hg). Defibrillation was attempted after 18 min of CPR. After return of spontaneous circulation, bradycardia required treatment in animals receiving vasopressin, especially with epidural anesthesia. Systemic acidosis was increased in animals receiving epinephrine than vasopressin, regardless of presence or absence of epidural anesthesia. We conclude that vasopressin may be a more desirable vasopressor for resuscitation during epidural block because the response to a single dose is longer lasting, and acidosis after multiple doses is less severe compared with epinephrine.
A C Krismer; Q H Hogan; V Wenzel; K H Lindner; U Achleitner; S Oroszy; B Rainer; A Wihaidi; V D Mayr; P Spencker; A Amann
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  93     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-08-28     Completed Date:  2001-09-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  734-42     Citation Subset:  AIM; IM    
Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Austria.
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MeSH Terms
Anesthesia, Epidural*
Blood Gas Analysis
Blood Pressure / drug effects
Cardiopulmonary Resuscitation*
Coronary Circulation / drug effects
Electrocardiography / drug effects
Epinephrine / pharmacology*
Heart Arrest, Induced
Hemodynamics / drug effects
Vasoconstrictor Agents / pharmacology*
Vasopressins / pharmacology*
Ventricular Fibrillation / prevention & control
Reg. No./Substance:
0/Vasoconstrictor Agents; 11000-17-2/Vasopressins; 51-43-4/Epinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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