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*Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Austria; and the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
Address correspondence to Anette C. Krismer, MD, Leopold-Franzens-University, Department of Anesthesiology and Critical Care Medicine, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to anette.krismer{at}uibk.ac.at Address reprint requests to Dr. Karl H. Lindner, Leopold-Franzens-University, Department of Anesthesiology and Critical Care Medicine, Anichstrasse 35, 6020 Innsbruck, Austria.
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 µg/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.
IMPLICATIONS: We evaluated the effects of repeated dosages of epinephrine versus vasopressin in a porcine cardiac arrest model with epidural anesthesia. Both epinephrine and vasopressin increased coronary perfusion pressure sufficiently in this setting. Vasopressin may be more desirable during epidural block because the response to a single dose is longer lasting and because acidosis after multiple doses is less severe compared with epinephrine.
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  A. Amann, K. Rheinberger, U. Achleitner, A. C. Krismer, W. Lingnau, K. H. Lindner, and V. Wenzel The Prediction of Defibrillation Outcome Using a New Combination of Mean Frequency and Amplitude in Porcine Models of Cardiac Arrest Anesth. Analg., September 1, 2002; 95(3): 716 - 722. [Abstract] [Full Text] [PDF]
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