Epinephrine Group Research Articles

Application of Hemocoagulase Bothrops Atrox in the submucosal injection for endoscopic submucosal dissection: a preliminary trial.

ObjectiveThis study aimed to evaluate the efficacy and safety of using Hemocoagulase Bothrops Atrox in the submucosal injection solution for endoscopic submucosal dissection (ESD).MethodsA total of 120 patients with superficial neoplastic lesions of the esophagus, stomach, and colon receiving ESD were randomly divided into two groups: The epinephrine group used epinephrine-containing submucosal fluid cushion for ESD, while the hemocoagulase group used Hemocoagulase Bothrops Atrox-containing submucosal fluid cushion for ESD. The preoperative, intraoperative, and postoperative clinical parameters and postoperative adverse events of the two groups were recorded, and comparative analysis within and between groups was performed.ResultsThere was no significant difference in the demographic and clinical characteristics between the hemocoagulase and epinephrine group (all P > 0.05). ESD surgery was completed in all patients. The hemocoagulase group had significantly shorter surgery time (P = 0.003) and less number of intraoperative bleeding (P = 0.010) than the epinephrine group. However, there was no significant difference in the incidences of postoperative delayed hemorrhage, and adverse events between the two groups (all P > 0.05). Multivariate linear regression demonstrated that the epinephrine group had significantly more number of intraoperative bleeding (B: 0.98, 95% confidence interval: 0.04–1.93) as compared with the hemocoagulase group.ConclusionCompared with epinephrine, using Hemocoagulase Bothrops Atrox in the submucosal injection for ESD surgery can significantly reduce the number of intraoperative bleeding, shorten the operation time, and did not elevate the incidence of adverse events.

Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

BackgroundThe administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest.ResultsAnesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance.ConclusionsDuring CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

Dexmedetomidine is an Excellent Additive to Local Anaesthesia for Postoperative Analgesia in Bilateral Third Molar Teeth Extraction Surgery

Background: We led this study to investigate the effect of injection of Dexmedetomidine as an additive to Lidocaine in the inferior alveolar nerve for patients undergoing lower bilateral impacted tooth extraction regarding postoperative pain, duration of postoperative analgesia, the over-all quantity of analgesia demanded in the first 24 h postoperatively, and the surgeon and the patient satisfaction. Patients and methods: Sixty patients were included, so that 30 patients were in the Dexmedetomidine group and the other 30 in the Adrenaline group. The inferior alveolar nerve block was done bilaterally after general anaesthesia using Lidocaine with Dexmedetomidine or Adrenaline. The primary outcome was analgesia quality (pain intensity, the duration of postoperative analgesia, and the patient's whole demanded amount of analgesia), the haemodynamic parameters, patients and surgeon’s satisfaction as secondary outcomes. Results: The mean postoperative analgesia time in Group (D) is 362.3±12.3 min, which is higher than Group (A) 231.4±13.1 min. 83.3% of the Group (D) received no analgesics, and 16.7% received one dose, while in the Group (A), 50% received two doses, 33.3% received one dose, and 16.7% received no doses. The VAS score was lower for Group (D) than Group (A) except for zero, where there was no difference between them. The satisfaction was higher in Group (D) than the Group (A) for both the patients and the surgeons. Conclusion: Adding 12.5μ/ml of Dexmedetomidine is an excellent additive to Lidocaine in Inferior alveolar nerve block regarding analgesia quality, patient and surgeon satisfaction in bilateral third molar teeth surgery.

Intralesional corticosteroid injections are less painful without local anesthetic: a double-blind, randomized controlled trial

Background Corticosteroid injections are a commonly used treatment for dermatologic pathologies. Although the injectable is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience no decrease in pain at the time of injection. Methods Patients requiring a corticosteroid injection were prospectively randomized into two cohorts to receive a corticosteroid (triamcinolone acetonide) combined with either lidocaine with epinephrine 1:100 000 (anesthetic) or bacteriostatic normal saline. Both patient and clinician were blinded to the treatment arm. The primary outcome was pain associated with the injection measured using a Visual Analog Scale (VAS) immediately following the injection. Results Thirty-one patients were enrolled with 18 in the saline group and 13 in the lidocaine with epinephrine group. Pain scores were significantly higher for injections containing lidocaine with epinephrine versus saline (VAS 5.0 vs 2.0, p = .0056). Conclusions For various dermatologic pathologies, corticosteroid injections are effective and have relatively little associated pain. Counterintuitively, we found that there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, clinicians should omit this anesthetic or dilute corticosteroids with normal saline, rather than with lidocaine and epinephrine. This will minimize injection pain as well as decrease the risk of pharmacologic adverse reactions from an unnecessary additional medication. Due to the small sample size, additional research may be necessary for generalization to other indications. Clinicaltrials.gov listing: NCT03630198

Effect of Magnesium Sulfate on Epinephrine-Mediated Adverse Effects during Liposuction Procedures: A prospective Randomized controlled Study

Background: During liposuction procedures, injection of wetting solution containing epinephrine is performed. This may increase the risk of cardiovascular side effects in large volume cases. Magnesium sulfate has cardioprotective effects, and can prevent complications related to epinephrine. The aim of the work: To assess the effect of adding intravenous magnesium sulfate, during the administration of epinephrine containing wetting solution, on the incidence of epinephrine-mediated cardiovascular side effects during liposuction surgery. Patients and Methods: This was a prospective randomized study comprised a total of 94 cases into two equal groups. The epinephrine group included 47 cases that had epinephrine in their wetting solution, and epinephrine-Mg group included the remaining cases that had adrenaline in the wetting solution along with intra venous. administration of MgSO4. Heart rate, blood pressure, arrhythmia incidence, isoflurane, and morphine consumption were recorded. Results: No significant difference was noticed as regard basal and induction heart rate and mean arterial pressure [MAP]. However, the epinephrine-Mg group showed significantly lower readings on subsequent assessment. There was no significant difference among both groups regarding the incidence of arrhythmia; the epinephrine group had more cases with arrhythmia. Isoflurane consumption decreased significantly in the epinephrine-Mg group in comparison with the epinephrine group, while morphine consumption did not significantly differ between them. Conclusion: Based on our findings, intravenous administration of magnesium sulfate decreases heart rate, blood pressure, and inhalational anesthesia consumption during liposuction. However, it has no significant impact neither on the incidence of arrhythmia, nor morphine consumption.

Effect of intramyometrial injection of epinephrine during abdominal myomectomy

Objective: To assess the effectiveness of intramyometrial injection of epinephrine inreducing blood loss in abdominal myomectomy and to compare it with pericervicaltourniquet.Methods: Randomized controlled study carried on sixty patients suffering fromsymptomatic uterine fibroids and counseled for abdominal myomectomy. The patientswere randomized into 3 groups of twenty each: control, tourniquet and epinephrinegroups. A comparative analysis of the intra and postoperative outcomes of thesegroups was performed assessing the duration of operation, the blood loss and theblood transfusion rate.Results: The epinephrine group had a statistically significant lower values of the fall inhaemoglobin level and a significantly lower mean operative blood loss than thetourniquet and the control groups. Furthermore, the mean duration of operation wassignificantly shorter in the epinephrine group.Conclusion: Intramyometrial injection of a solution of bupivacaine (50 ml of 0.25%) plusepinephrine (0.5 ml of 1 mg/ml) is very effective in reducing intraoperative bleedingduring abdominal myomectomy. This solution is significantly more effective than usingFoley's urethral catheter as a pericervical tourniquet. However it offers no additionalbenefits over using a pericervical tourniquet regarding the need for blood transfusion.

P0191 / #1905: RANDOMIZED DOUBLE BLIND CONTROLLED CLINICAL TRIAL ON EPINEPHRINE PLUS VASOPRESSIN VERSUS EPINEPHRINE PLUS PLACEBO IN PEDIATRIC INTENSIVE CARE CARDIOPULMONARY RESUSCITATION

Aims & Objectives: The primary outcome was to see the proportion of patients who achieved ROSC. The secondary outcomes were (i) survival rate (at 24 hours, PICU, hospital, and 90-day of discharge), (ii) functional status (at PICU, hospital, and 90-day of discharge), (iii) need for organ support(s), (iv) length of stay in PICU and hospital, (v) the number of cardiac arrests, and (vi) adverse effect(s) of the study drugs if any. Methods: Patients were randomized to receive Vasopressin 0.1 mL per kg (=0.8 IU per kg) or Placebo (0.1 mL per kg normal saline) in addition to Epinephrine (1:10000) 0.1 mL per kg. The drugs were given as bolus doses every three minutes until the return of spontaneous circulation (ROSC) was achieved or a maximum of five doses, whichever was earlier. Patients in whom vascular access was not available or ROSC was achieved by defibrillation without Epinephrine were excluded. Results: Ninety patients (Epinephrine plus Vasopressin group n=45 and Epinephrine plus Placebo group n=45) were analyzed on the intention to treat basis. There was no difference in the primary outcome between Epinephrine plus Vasopressin (55.5%), and Epinephrine plus Placebo groups (53.3%) (Relative risk 1.04, 95% CI 0.71 to 1.52; adjusted hazard ratio 0.56, 95% CI 0.29 to 1.08). There was no difference in survival rate at 24-hour (15.6% vs. 17.8%), at PICU, hospital, and 90-day post-discharge (2.2% vs. 2.2%). The number of cardiac arrests that required the study drugs was lower in Epinephrine plus Vasopressin group [median (IQR) 1, 1 – 1 vs. 1.5, 1 – 3; P=0.011]. No difference in other secondary outcomes was noted. Conclusions: A combination of Epinephrine plus Vasopressin did not improve the return of spontaneous circulation in pediatric intensive care cardiac arrest resuscitation.

The effect of high-dose intramuscular epinephrine on the recovery of spontaneous circulation in an asphyxia\u2010induced cardiac arrest rat model

BackgroundObtaining vascular access can be challenging during resuscitation following cardiac arrest, and it is particularly difficult and time-consuming in paediatric patients. We aimed to compare the efficacy of high-dose intramuscular (IM) versus intravascular (IV) epinephrine administration with regard to the return of spontaneous circulation (ROSC) in an asphyxia-induced cardiac arrest rat model.Methods Forty-five male Sprague-Dawley rats were used for these experiments. Cardiac arrest was induced by asphyxia, and defined as a decline in mean arterial pressure (MAP) to 20 mmHg. After asphyxia-induced cardiac arrest, the rats were randomly allocated into one of 3 groups (control saline group, IV epinephrine group, and IM epinephrine group). After 540 s of cardiac arrest, cardiopulmonary resuscitation was performed, and IV saline (0.01 cc/kg), IV (0.01 mg/kg, 1:100,000) epinephrine or IM (0.05 mg/kg, 1:100,000) epinephrine was administered. ROSC was defined as the achievement of an MAP above 40 mmHg for more than 1 minute. Rates of ROSC, haemodynamics, and arterial blood gas analysis were serially observed.ResultsThe ROSC rate (61.5%) of the IM epinephrine group was less than that in the IV epinephrine group (100%) but was higher than that of the control saline group (15.4%) (log-rank test). There were no differences in MAP between the two groups, but HR in the IM epinephrine group (beta coefficient = 1.02) decreased to a lesser extent than that in the IV epinephrine group with time.ConclusionsIM epinephrine induced better ROSC rates compared to the control saline group in asphyxia-induced cardiac arrest, but not compared to IV epinephrine. The IM route of epinephrine administration may be a promising option in an asphyxia-induced cardiac arrest.

Epinephrine Plus Vasopressin vs Epinephrine Plus Placebo in Pediatric Intensive Care Unit Cardiopulmonary Resuscitation: A Randomized Double Blind Controlled Clinical Trial

To compare the efficacy of epinephrine plus vasopressin vs epinephrine plus placebo in the pediatric intensive care unit (PICU) cardiopulmonary resuscitation (CPR). Randomized, double-blind controlled clinical trial. PICU in a tertiary care institute from February, 2019 to May, 2020. Children aged one month to 13 years who required CPR during PICU stay. Patients in whom vascular access was not available or return of spontaneous circulation (ROSC) was achieved by defibrillation without epinephrine were excluded. Patients were randomized to receive vasopressin 0.1 mL per kg (=0.8 unit per kg) or placebo (0.1 mL per kg normal saline) in addition to epinephrine (1:10000) 0.1 mL per kg. The drugs were given as bolus doses every three minutes until the ROSC or up to a maximum of five doses, whichever was earlier. The primary outcome was the proportion of patients who achieved ROSC. The secondary outcomes were survival rate and functional status (at 24-hour, PICU, hospital, and 90-day post-discharge), need for organ supports, length of stay (PICU and hospital), and adverse effect(s) of the study drugs. 90 patients (epinephrine plus vasopressin group, n=45 and epinephrine plus placebo group, n=45) were analyzed on intention-to-treat basis. There was no significant difference in the primary outcome between epinephrine plus vasopressin (n=25, 55.5%) and epinephrine plus placebo groups (n=24, 53.3%) (Relative risk 1.04, 95% CI 0.71 to 1.52). There was no significant difference in survival rate at 24-hour (n=7, 15.6% vs. n=8, 17.8%), at PICU, hospital, and 90-day post-discharge (n=1, 2.2% vs n=1, 2.2%). There was no difference in other secondary outcomes. No trial drug-related serious adverse events were observed. A combination of epinephrine plus vasopressin did not improve the rate of return of spontaneous circulation in the pediatric intensive care unit cardiopulmonary resuscitation as compared with epinephrine plus placebo.

Can topical epinephrine application to the papilla prevent pancreatitis after endoscopic retrograde cholangiopancreatography? Results from a double blind, multicentre, placebo controlled, randomised clinical trial

Background and study aimsPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a complication associated with important morbidity, occasional mortality and high costs. Preventive strategies are suboptimal as PEP continues to affect...

Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest

AimsWe recently reported early outcomes in patients enrolled in a randomised trial of adrenaline in out-of-hospital cardiac arrest: the PARAMEDIC2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial. The purpose of the present paper is to report long-term survival, quality of life, functional and cognitive outcomes at 3, 6 and 12-months. MethodsPARAMEDIC2 was a pragmatic, individually randomised, double blind, controlled trial with an economic evaluation. Patients were randomised to either adrenaline or placebo. This paper reports results on the modified Rankin Scale scores at 6-months, survival at 6 and 12-months, as well as other cognitive, functional and quality of life outcomes collected at 3 and 6 months (Two Simple Questions, the Mini Mental State Examination, the Informant Questionnaire on Cognitive Decline Evaluation for Cardiac Arrest, Hospital Anxiety and Depression Scale, the Post Traumatic Stress Disorder Checklist - Civilian Version, Short-Form 12-item Health Survey and the EuroQoL EQ-5D-5L). Results8014 patients were randomised with confirmed trial drug administration. At 6-months, 78 (2.0%) of the patients in the adrenaline group and 58 (1.5%) of patients in the placebo group had a favourable neurological outcome (adjusted odds ratio 1.35 [95% confidence interval: 0.93, 1.97]). 117 (2.9%) patients were alive at 6-months in the adrenaline group compared with 86 (2.2%) in the placebo group (1.43 [1.05, 1.96], reducing to 107 (2.7%) and 80 (2.0%) respectively at 12-months (1.38 [1.00, 1.92]). Measures of 3 and 6-month cognitive, functional and quality of life outcomes were reduced, but there was no strong evidence of differences between groups. ConclusionAdrenaline improved survival through to 12-months follow-up. The study did not find evidence of improvements in favourable neurological outcomes. (ISCRTN 73485024)

Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial.

BackgroundLignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique.MethodsThis was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure.ResultsThe onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate.ConclusionRopivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

Effect of Subcutaneous Adrenaline/Saline/Lidocaine Injection on Split-Thickness Skin Graft Donor Site Wound Healing.

Subcutaneous injection of tumescent solution, which contains local anesthetic, adrenaline, and saline, before split-thickness skin graft harvesting, shows a significant hemostatic effect. This method can reduce the initial bleeding from the donor site. The aim of this study is to assess the benefits of controlling the bleeding from donor sites by tumescent injection. A randomized, controlled trial was performed to compare the wound healing of split-thickness skin graft donor sites treated with or without tumescent injection. This randomized, controlled trial examined donor site healing days as the main measure of outcome. postoperative pain, donor site ulceration, and scar quality were evaluated as secondary outcome measures. Patients planned for split-thickness skin graft harvest were randomly assigned to receive either pre-harvest subcutaneous injection of local anesthetic, adrenaline, and saline solution (tumescent solution) (Group 1) or post-harvest application of adrenaline solution-soaked gauze to the skin graft donor sites (Group 2). Donor sites were treated with calcium alginate dressings after graft harvesting. On the 10th postoperative day, the dressings were removed and donor site healing were measured. Follow-up evaluation of scar quality was performed 6 months after surgery. Postoperative pain was evaluated on the 1st day after operating. Forty-five patients (26 males; average age 61.8 years) completed the late follow-up evaluation (6 months postoperatively), with 26 patients in group 1 and 19 in group 2. There were no significant differences between the two groups in any of the outcome measures. Tumescent technique provides sufficient hemostasis in split skin graft donor sites, especially the initial bleeding just after graft harvesting, without any negative effects. Larger series should be studied to evaluate the effect in donor site wound healing.

Minimizing bleeding in laparotomic myomectomy: A comparative study

Objective: To compare the effectiveness of pericervical tourniquet versus intra-myometrial injection of epinephrine in reducing blood loss in abdominal myomectomy. Study Design: A prospective analysis, over 1 year. Setting: University hospital’s Gynaecology centre. Subjects & Methodology: A total of 60 patients presenting with mass-matched uterine fibroid(s), and underwent abdominal myomectomy were studied, allocated into 3 groups; 20 patients each. Group 1 (tourniquet group), where a tourniquet was applied at the cervico-uterine junction from the start of surgery. Group 2 (epinephrine group), where intra-myometrial injection of epinephrine was undertaken at surgery. Group 3 (control) myomectomy was done without blood loss-reducing measures. Results: Group 2 showed a significant reduction in blood loss. No difference between groups in terms of need of blood transfusion nor febrile morbidity. Conclusions: Intra-myometrial injection of epinephrine at the start of abdominal myomectomy seems a simple, and effective method to reduce blood loss during surgery and facilitate the enucleation of the myoma. Keywords: Tourniquet, Myomectomy, Epinephrine.

Nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis: Single Center Study.

Objectives: To compare the outcome of nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics, Federal Government Polyclinic Hospital, Islamabad. Period: 6 month (1st October, 2016 to 1st April, 2017). Material & Methods: Children fulfilled selection criteria were enrolled. Then patients were randomly divided in two groups by using lottery method. In Group A, children received salbutamol. In group B, children received nebulized adrenaline. After 48 hours, children were evaluated for heart rate, respiratory rates, oxygen saturation and Respiratory Distress Assessment Index (RDAI) score. All the information was collected using proforma. Data was analyzed using SPSS version 21. Results: The mean age of children was 10.45±6.70 months in epinephrine group and13.07±6.28 months in salbutamol group. There were 29 (52.7%) males & 26 (47.3%) females in both groups. After 48 hours, mean heart rate was 122.58±4.75bpm with epinephrine while 127.87±4.4.44bpm with salbutamol. Mean respiratory rate was 35.16±3.29bpm with epinephrine while 39.84±3.32bpm with salbutamol. Mean RDAI score was 8.35±1.36 with epinephrine while 10.07±1.37 with salbutamol. Mean oxygen saturation was 85.24±2.74% with epinephrine while 80.38±3.26% with salbutamol. The difference was significant (P<0.05). Conclusion: Thus the nebulized epinephrine was found to be more effective in maintaining heart rate, respiratory rate, oxygen saturation and RDAI score of children as compared to salbutamol.

Abstract 146: Association of Epinephrine Prior to Defibrillation with Survival in Patients with In-hospital Cardiac Arrest

Background: Prompt defibrillation is a first line treatment for in-hospital cardiac arrest (IHCA) due to a shockable rhythm, with epinephrine recommended only when defibrillation is ineffective. However, empirical data regarding epinephrine prior to first defibrillation for shockable IHCA and its association with survival are unavailable. Methods: Using 2000-2018 Get with the Guidelines Resuscitation data, we identified adults ( > 18 years) with an index IHCA due to an initial shockable rhythm. We conducted a time-dependent propensity-matched analysis to evaluate the association of epinephrine prior to first defibrillation with survival to discharge and acute resuscitation survival (i.e., return of spontaneous circulation for > 20 minutes). Results: Among 34,688 subjects, 10,057 (29.0%) received epinephrine before defibrillation. Median age was 67 years in both groups. Compared to defibrillation first, patients in the epinephrine first group were less likely to have myocardial infarction or heart failure, but more likely to have renal failure, sepsis and pneumonia, be located in an intensive care unit, and already receiving mechanical ventilation (P <0.001 for all). Treatment with epinephrine first was strongly associated with a delay in first defibrillation (median 3 min vs. 0 min; P <0.001). In propensity-matched analysis, epinephrine prior to defibrillation was associated with lower odds of survival to discharge (OR: 0.81, 95% CI 0.76 - 0.86) and acute resuscitation survival (OR: 0.79, 95% CI 0.74 - 0.84). Early epinephrine was associated with lower survival (OR: 0.87, 95% CI 0.78-0.97) and acute resuscitation survival (OR for acute resuscitation survival: 0.83, 95% CI 0.74-0.93) even in patients who received defibrillation within 2 minutes. Conclusions: Despite a strong emphasis on prompt defibrillation in current guidelines, nearly 1 in 3 patients with IHCA due to a shockable rhythm received epinephrine prior to first defibrillation. Epinephrine before defibrillation was associated with worse survival outcomes. Although delays in defibrillation were more common in the early epinephrine group, early epinephrine remained associated with worse outcomes even in patients who received prompt defibrillation.

Comparing Analgesic Effect of Intravenous Fentanyl, Femoral Nerve Block and Fascia Iliaca Block During Spinal Anesthesia Positioning in Elective Adult Patients Undergoing Femoral Fracture Surgery: a Randomized Controlled Trial.

BackgroundFemoral fracture is the most painful bone injury and performing spinal anesthesia is extremely challenging due to very poor positioning unless we have a very good mode of analgesia. Intravenous strong opioids are commonly used but to date nerve blocks are also being utilized. The reliability and effectiveness of the aforementioned methods are not conclusive to practice worldwide. The objective of the study was to compare the analgesic effect of intravenous fentanyl, femoral nerve block (FNB) and fascia iliaca block (FICB) during positioning patients with femoral fracture for spinal anesthesia.MethodsA randomized controlled trial study was conducted on 72 elective adult patients with femoral fracture aged 18–65 years and ASA I and II those were allocated randomly into three groups. The intravenous fentanyl (IVFE) group received 1µg/kg IV fentanyl, FNB group received nerve stimulator guided FNB with 30 mL of 1% lidocaine with adrenaline and FICB group received FICB with 30 mL of 1% lidocaine with adrenaline. Pain intensity in numeric rating score (NRS), time to perform spinal anesthesia, quality of positioning and patient acceptance were assessed. SPSS version 26 and Kruskal–Wallis test were used to analyze data and p value <0.05 was considered significant.ResultsNRS Pain score during positioning was significantly lower in FNB and FICB groups than IVFE group [median (IQR)]; 2 (1–2.5), 2 (2–3)) vs. 3 (3–4) respectively; P<0.001 and P=0.001. However, FNB and FICB groups were not significantly different with (P=1.000). Time to perform spinal anesthesia was significantly longer in IVFE group 9.5 (9–10) minutes than both FNB and FICB groups 7 (6–8), 8 (6–8) respectively, P<0.001. The quality of positioning was significantly lower in the IVFE group than both FNB and FICB groups (P<0.001).ConclusionPreoperative FNB and FICB reduce pain score during positioning, shorten time to perform spinal anesthesia, better patient positioning and higher patient acceptance in a patient undergoing elective femoral bone fracture surgery.Trial RegistrationPan African Clinical Trial Registry, PACTR202006669166858, registered on June 19, 2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12127.

Efficacy of Epinephrine Injection in Preventing Post-ERCP Pancreatitis.

Rectal indomethacin or a topical spray of epinephrine to the papilla of Vater has each shown efficacy alone in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We supposed that a submucosal epinephrine injection would be more effective and longer acting than a topical epinephrine spray and therefore would further reduce the incidence of PEP. A retrospective analysis was conducted of 412 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2017 and December 2019. These patients were divided into 2 groups: the indomethacin group and the indomethacin plus the submucosal epinephrine injection group. The incidence rates and severity of PEP, post-ERCP hyperamylasemia, other outcomes, and any other adverse events were compared between the groups. Baseline demographic and clinical characteristics and procedure-related parameters were similar between the 2 groups. The incidence of PEP was 0.4% in the epinephrine group compared with 5.1% in the indomethacin group (P<0.001). Post-ERCP hyperamylasemia occurred in 24.6% of patients in the indomethacin group, whereas 7.6% of patients in the epinephrine group developed this condition; the difference was significant (P<0.001). Postsphincterotomy bleeding occurred in 5 patients, all of whom were in the indomethacin group (P<0.001). Other adverse events, including arrhythmias, acute coronary events, stroke, or hypertension were not significantly different between the 2 groups. Addition of a submucosal epinephrine injection in conjunction with rectal indomethacin significantly reduced the incidence of PEP, post-ERCP hyperamylasemia, and postsphincterotomy bleeding.

Topical use of tranexamic acid versus epinephrine to optimise surgical field during exploratory tympanotomy

ObjectiveTo explore the effect of diluting tranexamic acid as 1000 mg versus epinephrine as 1 mg in a volume of 200 mL of normal saline used for local washing and rinsing of the used gauze at the surgical bleeding sites during microscopic ear surgeries. MethodsIn a randomised, double-blind trial, sixty patients scheduled for elective microscopic exploratory tympanotomy consented to participate after meeting the inclusion criteria. Patients assigned using the balanced block randomisation method into two similar groups; one received tranexamic acid (TXA), and the other received epinephrine. The outcome of the study focused on blood pressure, heart rate, quality of surgical field assessed via Boezaart score, the volume of bleeding, and the incidence of complications. ResultsThe more prominent findings were the statistically significant and favourable surgical field assessment according to the Boezaart score, and lower estimates of bleeding demonstrated in the TXA group compared to the epinephrine group, along the time of the study P-value was < 0.05. The haemodynamic monitoring showed promising changes in the TXA group compared with the epinephrine group in terms of lower mean blood pressure and lower heart rate that reached the level of statistical significance during the time of the study. Conclusionthe use of topical tranexamic acid during microscopic ear surgeries is associated with a better surgical field, less bleeding, and favourable haemodynamic parameters compared to epinephrine.

Impact of Local Anesthesia on Wound Healing

Different local anesthetics produce multiple effects on wound healing, although this effect did notdemonestrated clearly in experimental study. This study aimedto evaluate the effects of several localanesthetics (lidocaine, articaine, mepivacaine) on healing of oral mucosal wound healing in experimentalrabbits by histological examination.The study was conducted on eight healthy adult male New Zealandwhite rabbits which divided into four group(n=2) control group which received no treatment group two(received lidocaine 2% with adrenalin) group three (received mepivacaine) and group four (receivedarticaine 4%). oral mucosal wound were initiated experimentally in all group and each group received theirtreatment by local application one time daily for six day(except control group) in the third day half of theanimal were sacrificed in each group and histological examination for the wound area were conducted , theremaining animal were sacrificed in the sixth day of treatment and histological examination were made forthe wound area to compare the result between the four group. The mepivacaine group produce better result(enhance healing of the oral mucosal wound) followed by atricaine and lidocaine group compared withcontrol one. This study showed that different type of local anesthesia produces different effects on woundhealing manufisted histologically and clinically.