Vasopressor Effect of Epinephrine with and without Dopamine during Cardiopulmonary Resuscitation

1988 ◽  
Vol 22 (11) ◽  
pp. 868-872 ◽  
Author(s):  
Edgar R. Gonzalez ◽  
Joseph P. Ornato ◽  
Ronald L. Levine

We prospectively studied nine prehospital cardiac arrest patients (six M, three F; aged 60 ± 8 yr) to determine the vasopressor response following incremental (1, 3, and 5 mg) doses of intravenous epinephrine given 5 minutes apart with or without dopamine 15 μg/kg/min. All patients were in ventricular fibrillation on arrival of the paramedics and were not resuscitated with standard advanced cardiac life support therapy. Cardiopulmonary resuscitation (CPR) was performed with a computerized Thumper at 60 compressions/min with a 50:50 downstroke-to-upstroke ratio. All patients were intubated and received 12 ventilations/min at a fraction of inspired oxygen of 80 percent. Radial artery pressure was monitored through a #20 gauge radial artery catheter inserted by cutdown within ten minutes after arrival at the emergency room. Five patients received epinephrine alone (group A) and four received epinephrine plus dopamine (group B). The patient's age, paramedic response time, arterial blood gases, and initial diastolic blood pressure (BP) did not differ significantly between treatment groups. Baseline systolic BP was significantly higher (p < 0.01) in group B (68 ± 10 mm Hg) than in group A (35 ± 5 mm Hg). Epinephrine produced a dose-dependent vasopressor response in group A, but not in group B. In group A, peak systolic BP following epinephrine 1, 3, and 5 mg was 57 ± 20, 69 ± 23, and 76 ± 27 mm Hg, respectively (p < 0.05 for 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (81 ± 13, 80 ± 18, and 78 ± 19 mm Hg). In group A, peak diastolic BP following epinephrine 1, 3, and 5 mg was 24 ± 8, 28 ± 16, and 31 ± 6 mm Hg, respectively (p < 0.05 for epinephrine 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (33 ± 10, 33 ± 11, and 34 ± 13 mm Hg). Epinephrine produces a dose-dependent vasopressor response during CPR in humans. The administration of high doses of epinephrine to patients receiving high-dose dopamine does not produce an additive vasopressor response.

2017 ◽  
Vol 94 (1108) ◽  
pp. 81-86 ◽  
Author(s):  
Stylianos A Michaelides ◽  
Avgerinos-Romanos Michailidis ◽  
George D Bablekos ◽  
Antonis Analitis ◽  
Maria Michalatou ◽  
...  

BackgroundInconsistent and contradictory findings have appeared in the literature concerning the impact of body position on oxygenation in pleural effusion.MethodsWe attempted to elucidate whether the size of the pleural effusion in patients with no parenchymal disease is the main determinant of posture-induced alterations in oxygenation parameters. We studied 62 spontaneously breathing patients aged 65.3±7.8 years (mean±SD), of whom 36 had large and massive-sized effusions (Group A) and 26 had small and moderate-sized effusions (Group B). Arterial blood gases were determined in four different body positions: sitting (SIT), supine (SUP), ipsilateral (IPS) and contralateral (CON) to the effusion side, after remaining relaxed for at least 20 min in each position. Separation into groups A and B was deliberately set from the position of the fluid meniscus line on a posteroanterior chest film just above the upper costal margin of the sixth anterior rib. A two-way ANOVA model with outcome variables PaO2, PaCO2 and [A–a] DO2 was used.ResultsIn both groups the best oxygenation was found in SIT. The worst oxygenation (highest [A–a] DO2 value) occurred in group A in CON compared with IPS (59.4±7.6 vs 49.0±7.5 mm Hg, p<0.001) and in group B in IPS compared with CON (51.0±8.7 vs 39.5±9.2 mm Hg, p<0.001). Also, PaCO2 showed significant differences in both groups in IPS compared with CON (p=0.002).ConclusionsPatients with large-sized effusions exhibit the worst oxygenation when lying on the side contralateral to the effusion, while those with small-sized effusions exhibit the worst oxygenation when lying on the side ipsilateral to the effusion.


2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Basant H. Elrefaey ◽  
Mohamed S. Zidan

Abstract Background Tracheal intubation exposes mechanically ventilated patients to serious pulmonary complications such as ventilator-associated pneumonia (VAP). This study was conducted to compare the efficacy of manual hyperinflation in supine versus lateral decubitus position on arterial blood gases (ABG) in patients with VAP. Forty-two patients with ventilator-associated pneumonia with age range from 40 to 60 years were selected. They were randomly divided into two equal groups: group A who received manual hyperinflation from supine position and group B who received manual hyperinflation from lateral decubitus position (upper most affected). Both groups received respiratory physiotherapy. The patients received 2 sessions per day for 6 days. Outcome measures were arterial blood gases (PaO2, PaCO2, PaO2/FiO2, and SaO2). They were assessed before the 1st morning session (pre), at day 3 (post 1), and at day 6 (post 2). Results After sessions, significant changes of measured variables (PaO2, PaCO2, PaO2/FiO2, and SaO2) were obtained in both groups (P < 0.05, in all variables) and by comparison between groups post-intervention; a significant difference was observed between both groups in measures of oxygenation in favor of group B (P < 0.05), whereas there was a non-significant difference in the PaC02 between both groups (post 1 P = 0.52 and post 2 P = 0.33). Conclusion It was concluded that effect of the bag squeezing on arterial blood gases in patients with ventilator-associated pneumonia from lateral decubitus position was more effective than from supine position. Trial registration PACTR, PACTR201909817075549. Registered October 21, 2018—retrospectively registered https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4655


Author(s):  
Majid Naderi ◽  
Maryam Judi ◽  
Maryam Yazdanparast ◽  
Sima SavadKuhi ◽  
Saeedeh Yaghoubi

Background: Cardiomyopathy usually causes a cardiac dysfunction resistant to treatment due to anthracycline. This study aimed to evaluate the changes in Tei-Index (myocardial performance index) in patients with malignancies treated with anthracycline. Material and Methods: This case-control study was done on 15 children who were treated with low-dose anthracycline (1-199mg/kg) called group A and 15 children who were treated with high dose (>200mg/kg) anthracycline called group B after acquiring consent from their parents. Children with no abnormality in Echo-Doppler results were included in this study. The patients’ age range between 1- 17 years with a mean age of 6.57 years. Another group of healthy children were assigned to group C as a control group who had not received chemotherapy. The first echo was performed right before the treatment and the second one, two weeks after completing chemotherapy.  Data were analyzed by the SPSS statistical software. Results: Changes in mean Tei-index in group A were 0.36 ± 0.04 before treatment and 0.43 ± 0.11 after treatment. Changes in mean Tei-index in group B were 0.37 ± 0.04 before treatment and 0.45 ± 0.06 after treatment. There was no significant difference between the two groups using the independent T-test. (p-value= 0.57). No significant correlation between the changes in mean ejection fraction (EF) and treatment was found in the three groups (p-value=0.45). Conclusion: This study showed a change in the Tei-index (MPI) in patients receiving anthracycline; regardless of the dosage, they got in their regimen. Given the use of anthracycline, any abnormal cardiac finding can alert the physicians to the possibility of cardiomyopathy, hence scheduling routine follow-ups are necessary.


2020 ◽  
Author(s):  
Alaa Rashad ◽  
Mohamed Shahat Badawy ◽  
Mohammed Mustafa Ali ◽  
Haggagy Mansour ◽  
Mohamed Abdel Bary

Abstract Background: Malignant endobronchial obstruction (MEBO) is the most debilitating complication in non-small cell lung cancer (NSCLC). The therapeutic role of cryotherapy and its impact on survival has not been well addressed. This is to clarify whether the combination of endobronchial cryotherapy (EBCT) and chemoradiotherapy (CRT) improved the outcomes in inoperable NSCLC patients with symptomatic MEBO compared to that obtained by CRT alone.Methods: A prospective ranomized cohort study included 60 cases presented to Qena University Hospital, Egypt, between December 2016 and May 2019. Group A included 30 patients were managed with EBCT plus CRT. Group B included 30 patients were managed with CRT alone. The outcomes assessed were symptoms relief, respiratory function tests (RFT), performance status and survival outcomes at baseline and 4 weeks of follow-up.Results: Group A patients showed a highly significant improvement in symptoms, RFT, 6MWD test and arterial blood gases, compared to group B. The mean Karnofsky score increased from 57.33±5.67 % at baseline to 60.67±6.39 % post-EBCT (P=0.036); group A was significantly improved compared to group B (P=0.04). The Kaplan-Meier median survival for all patients was 9.7±0.4 months (95% CI= 8.86-10.54), and group A cases (10.77±0.44 months, 95% CI= 9.9 -11.6) was significantly longer than that of group B cases (8.6±0.68 months, 95% CI= 7.3-9.97; T-test = 2.631, P= 0.011). Conclusion: The use of EBCT with CRT for the management of MEBO in symptomatic patients with inoperable NSCLC is an efficient and safe procedure. EBCT improves the clinical outcomes, RFT, performance status and median survival.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Asmaa Abd Elfattah Saafan ◽  
Mohammed Sidky Mahmoud Zaki ◽  
Safaa Ishak Ghaly ◽  
Ahmed Moneir Ahmed Youssef

Abstract Objectives Post dural puncture headache (PDPH), since it is first described by August Bier in 1898, remains a common complication in spinal anesthesia (SA). Many pharmacological agents are suggested for PDPH management as acetaminophen, caffeine, non-steroidal antiinflammatory drugs, corticosteroids, and sumatriptan. Aim The aim of this study is to compare between the prophylactic effect of each of; aminophylline, gabapentin, and neostigmine added to atropine on the occurrence of PDPH after caesarean section (CS) under SA. Subjects and Methods This prospective randomized controlled clinical study was carried out 75 pregnant female patients 20-40 y, 60-100 kg. ASA physical status II undergoing elective CS. Patients were randomly divided into 3 groups (25 patients in each); group A: received 250 mg aminophylline IV immediately after delivery of the infant, group B: received IV neostigmine 20 µg/kg added to atropine 10 µg/kg immediately after delivery of the infant and group C: received 3 capsules gabapentin 300 mg; the 1st before SA by 2 h with sip of water, the 2nd after CS by 6 h and the 3rd after 14 h from CS. Results The incidence of PDPH was lower in group A (8% vs 40% in group B and 24% in group C. The onset of PDPH was significantly delayed in group C than group A and in group C than B, but insignificant between group A and B. The duration of PDPH and total dose of analgesic requirement was significantly lower in group A than group B and C and in group B than C. Heart rate (HR) showed significant increase in group A (post aminophylline than pre) only. HR in the other groups and mean arterial blood pressure showed insignificant difference among the three groups (between pre and post administration of drugs). As regards VAS, there was no significant difference in the three groups at 3 h. There was significant difference among the three groups at 6, 12, 24, 36, 48 and 72 h. (between group A & B from 24h up to 72h, between group A & C from 6 up to 72h and between group B & C at 6 h only (delayed onset with neostigmine)). Side effects were minimal and tolerable. Conclusion Aminophylline reduced the incidence and duration of PDPH after CS under SA more than gabapentin and neostigmine with less analgesic requirement and minimal side effects. Also, neostigmine was superior than gabapentin in delaying the onset and decreasing the duration of PDPH.


2020 ◽  
Vol 10 (7) ◽  
pp. 1116-1121
Author(s):  
Jing Wang ◽  
Xinhong Wang ◽  
Min Li ◽  
Suxiang Fan

The objective of this study was to observe the clinical effect of Chitosan nanoparticles therapy on Helicobacter pylori (HP) infection. Three treatment groups (A, B, and control group C) were randomly assigned with 60 cases of HP each, making 180 cases. Group C received standard triple therapy (omeprazole + amoxicillin + clarithromycin), group A got a routine dose of Chitosan nanoparticles plus triple therapy, and group B got a high dose of Chitosan nanoparticles plus triple therapy. The course of treatment in each group was 7 days. The eradication rate, clinical efficacy and adverse reactions were observed. Up to 172 patients finished the experiment, with 59 patients in Group A, 57 in Group B and 56 in Group C. In a total analysis set (FAS), the eradication rates of HP in Group A, Group B and Group C were 80.00%, 80.70%, and 71.67%, respectively. There was no significant difference between the two groups (P > 0.05). In accordance with the PPS, the HP eradication rates of group A, B, and C were 81.36%, 80.70% and 76.79%, respectively, and there was no significant difference between the two groups (P > 0.05). The clinical efficacy of group A, B, and C were 91.67%, 91.23%, and 70.00%, respectively. The differences among the three groups were statistically significant (P < 0.05). In accordance with the PPS, the clinical efficacy of group A, B and C was 93.22%, 91.23%, and 75.00%, respectively. With a P-value of less than 0.05, the results indicated that the difference between the two groups was statistically significant. There were 21 adverse reactions in the experiment, including 3 in group A, 6 in group B, and 12 in group C. The difference was statistically significant (P < 0.05) between group A and B compared with group C, the difference was statistically significant (P < 0.05); the difference between group A and group B was statistically significant (P < 0.05). In conclusion the therapeutic effect of Chitosan nanoparticles and oral liquid, combined with triple therapy on HP infection is satisfactory, with less adverse reactions are. However, the findings suggest that it is not desirable to use a high dose Chitosan nanoparticles and oral liquid.


2019 ◽  
Vol 18 (2) ◽  
pp. 7-15
Author(s):  
Mallika Rayamajhi ◽  
Puja Thapa ◽  
Anjan Khadka ◽  
Biswa Ram Amatya ◽  
Udaya Bajracharya

Introduction: While most intravenous induction agents decrease arterial blood pressure, laryngoscopy and endotracheal intubation increase the heart rate and blood pressure. Propofol causes a decrease in systemic blood pressure whereas etomidate has minimal effects on the cardiovascular system. This study aims to evaluate and compare the hemodynamic effects of propofol and etomidate during induction and endotracheal intubation. Methods: 62 ASA I and II patients, 20-60 years of age, scheduled for elective surgery were enrolled in this prospective, randomised and double blind comparative study. Group A received inj. Propofol (2 mg/kg) and group B received inj. Etomidate (0.3 mg/kg), as induction agents. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded after induction and after intubation at one, three, five and ten minutes and intergroup comparisons were made. Results: After induction the decrease in systolic, diastolic and the mean arterial pressures were more in group A compared to group B (p = 0.003, 0.004 and 0.002). After 1 minute of intubation all haemodynamic parameters increased from the baseline with no significant differences between the two groups (p >0.05). At three minutes the decrease in heart rate, diastolic blood pressure and mean arterial pressure was more in group A than group B with p values of 0.001, 0.002 and 0.05, however systolic blood pressures showed no significant difference (p = 0.144). The decrease in blood pressures showed significant difference between the two groups (p <0.05) at five and ten minutes but the decrease in heart rate remained significant only at five minutes of intubation (p = 0.001). Conclusions: Propofol and etomidate are both effective in preventing the haemodynamic changes due to induction and endotracheal intubation, with etomidate providing more haemodynamic stability.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xianwei Jin ◽  
Qiaoling Weng ◽  
Jia Min

Objective. To evaluate a new haemostasis method using an ultrasound probe to compress the radial artery and haemostasis under direct vision to replace traditional manual compression of the radial artery. Methods. According to a random number table, 240 patients with gastrointestinal tumours who had undergone arterial puncture were divided into Group A (120 cases) and Group B (120 cases). In Group A, patients were under the guidance of ultrasound to confirm the vascular port, determine the compression position of the ultrasound probe, observe the degree of vascular deformation, and press the radial artery puncture port with pressure to stop bleeding under direct vision. In Group B, traditional manual compression was used. All patients received 5 min of compression for haemostasis, and haemostasis conditions were recorded after compression and 24 hours postoperatively. Results. The incidence of bleeding, haematoma, and skin ecchymosis at the puncture site after 5 minutes of compression in Group A was lower than that in Group B ( P < 0.05 ). No significant difference was found between the two groups at 24 hours after the operation ( P > 0.05 ). Conclusion. The method using an ultrasound probe to guide radial artery compression to haemostasis is better than traditional manual compression when applied for compression haemostasis after removing the radial artery catheter.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5022-5022
Author(s):  
Antoine Italiano ◽  
Emmanuel Chamorey ◽  
Cyril Foa ◽  
Frédéric Peyrade ◽  
Josiane Otto ◽  
...  

Abstract Autologous peripheral blood stem cell (PBSC)- supported high-dose melphalan (HDM) is now considered standard therapy in the treatment of multiple myeloma, at least for patients under 65 years. Oral mucositis is a frequent non-hematological complication which causes severe pain, interferes with patient nutrition and can lead to systemic infection. Amifostine (WR-2721; Ethyol), a phosphoaminothiol, is a prodrug that protects a broad range of normal tissues from the cytotoxic damage induced by anticancer agents. We retrospectively compared two groups of patients with stage II/III previously untreated multiple myeloma who received between April 96 and May 2004 an induction chemotherapy with 3 or 4 cycles of VAD (vincristine, adriamycin, dexamethasone) followed by HDM (200 mg/m²) and autologous PBSC transplantation. These two groups either received (group A, n = 10 ) or did not receive (group B, n= 32) amifostine (740 mg/m²) before HDM. The occurrence of grade 3/4 oral mucositis was significantly decreased in group A in comparison to group B (10% versus 53%, p =0.023) with no difference for the time to mucosal recovery. Supportive care differed between the two groups: only 2 patients (20%) needed opioid treatment in group A versus 22 patients (69%) in group B ( p=0.005) and 1 patient (10%) required parenteral nutrition in group A compared to 16 patients (50%) in group B (p= 0.015). The occurrence of severe infectious complications did not differ between the two groups (0% versus 12,5%, p= 0.56). Amifostine did not affect haematological recovery, the median time to granulocyte recovery to > 500/μl was similar in the two groups (8,4 days versus 9,9 days, p=0.22). Moreover, there is no statistically significant difference between the amifostine and control group for the disease response. The tolerability of amifostine was excellent and no adverse effects were reported. This study suggest that amifostine can reduce mucosal damage associated with high dose melphalan-based therapy, reducing, as a consequence, the necessity of nutrition and analgesic support, without compromising therapeutic benefit. Obviously, these interesting results have to be confirmed by larger randomised trials.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Alaa Rashad ◽  
Mohamed Shahat Badawy ◽  
Mohammed Mustafa Ali ◽  
Haggagy Mansour ◽  
Mohamed Abdel-Bary

Abstract Background Malignant endobronchial obstruction (MEBO) is the most debilitating complication in non-small cell lung cancer (NSCLC). The therapeutic role of cryotherapy and its impact on survival has not been well addressed. This is to clarify whether the combination of endobronchial cryotherapy (EBCT) and chemoradiotherapy (CRT) improved symptoms, respiratory functions, performance status, and survival outcomes in inoperable NSCLC with symptomatic MEBO compared to that obtained by CRT alone. Results A prospective cohort study included 60 cases presented to Qena University Hospital, Egypt, between December 2016 and May 2019. They were divided into two groups. Group A included 30 patients who were managed with EBCT plus CRT. Group B included 30 patients who were managed with CRT alone. The outcomes assessed were symptoms relief, respiratory function tests (RFT), performance status, and survival outcomes at baseline and 4 weeks of follow-up. Group A patients showed a highly significant improvement in symptoms (cough, dyspnea, and hemoptysis), RFT, 6MWD test, and arterial blood gases, compared to group B. The mean Karnofsky score increased from 57.33±5.67% at baseline to 60.67±6.39% post-EBCT (P=0.036); group A was significantly improved compared to group B (P=0.04). The Kaplan-Meier median survival for all patients was 9.7±0.4 months (95% CI= 8.86–10.54), and group A cases (10.77±0.44 months, 95% CI= 9.9–11.6) was significantly longer than that of group B cases (8.6±0.68 months, 95% CI= 7.3–9.97; T test = 2.631, P=0.011). Conclusion The use of EBCT with CRT for the management of MEBO in symptomatic patients with inoperable NSCLC is an efficient and safe procedure. EBCT improves clinical outcomes, RFT, performance status, and median survival. Trial registration ClinTrial.Gov registration: NCT04710459 on 4/3/2021.


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