Adrenaline

Class

  • a catecholamine

Mechanism of Action

  • direct acting sympatheomimetic -> alpha & beta agonist
  • low doses -> beta-effects -> increase HR and Q
  • higher doses -> alpha-effects
  • maintains coronary & cerebral blood flow

Pharmaceutics

  • opaque ampoule (1:1000), mini jets

Dose

  • bolus -> 0.01 -> 0.5mcg/kg/min IV (give through CVL for safety)

Indications

  1. Anaphylactic/oid shock
  2. Asystole
  3. Low cardiac output states
  4. Glaucoma
  5. Local vasoconstictor
  6. Added to LA to increase duration of action

Adverse Effects

  • hypokalaemia
  • hypophosphataemia
  • hyperglycaemia
  • lactataemia
  • caution with MAO-I

PK

  • Absorption – IV, IM, nebulised, topical
  • Distribution –
  • Metabolism – hepatic + adrenergic nerve endings (COMT and MAO)
  • Elimination – inactive products appear in urine

Evidence

CAT Study Investigators (2009 – Int Care Med)

  • Australasian Trial
  • RCT looking at Noradrenaline vs Adrenaline to treat hypotension (sepsis or cvs failure)
  • n = 208
  • -> no significant difference in mortality, LOS, ventilation, shock duration
  • -> adrenaline – transient lactic acidosis, hyperglycaemia, tachycardia

Annane (2007, Lancet)

  • MRCT
  • noradrenaline vs adrenaline in septic shock
  • n = 330
  • -> no significant difference in mortality, BP, time to haemodynamic stability, duration of vasopressor therapy, time to organ dysfunction resolution, adverse effects

SUMMARY

Myburg (2008) – “The case for Adrenaline” Critical Care and Resuscitation, Volume 10 (3) page 178

  • poor quality evidence
    -> no difference in outcomes

CCC Pharmacology Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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