Faculty Collaboration Database

The efficacy of epinephrine or vasopressin for resuscitation during epidural anesthesia. Anesth Analg 2001 Sep;93(3):734-42

Date

08/29/2001

Pubmed ID

11524349

DOI

10.1097/00000539-200109000-00038

Scopus ID

2-s2.0-0034865333 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

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.

Author List

Krismer AC, Hogan QH, Wenzel V, Lindner KH, Achleitner U, Oroszy S, Rainer B, Wihaidi A, Mayr VD, Spencker P, Amann A

Author

Quinn H. Hogan MD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anesthesia, Epidural
Animals
Blood Gas Analysis
Blood Pressure
Cardiopulmonary Resuscitation
Coronary Circulation
Electrocardiography
Epinephrine
Female
Heart Arrest, Induced
Hemodynamics
Male
Swine
Vasoconstrictor Agents
Vasopressins
Ventricular Fibrillation