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At least 19 recordsLinked to original sources
PubMed1996

Stability of epinephrine hydrochloride in an extemporaneously compounded topical anesthetic solution of lidocaine, racepinephrine, and tetracaine.

The stability of lidocaine, epinephrine (as racepinephrine, or racemic epinephrine), and tetracaine (LET) in a topical anesthetic solution under various conditions was studied. The LET solution was prepared by mixing together 100 mL of 20% lidocaine hydrochloride, 50 mL of 2.25% racepinephrine (as the hydrochloride salt), 125 mL of 2% tetracaine hydrochlorides 315 mg of sodium metabisulfite, and 225 mL of water. The solution was stored in three amber glass and two clear glass bottles. One amber container and one clear container were stored at 35 degrees C, one amber and one clear container were stored at room temperature (approximately 18 degrees C), and the third amber container was stored at 4 degrees C. Except for the refrigerated container, each bottle was subjected to continuous room light. Each of the five solutions was sampled at 0, 1, 2, 3, 4, 8, 16, and 26 weeks for visual inspection and high-performance liquid chromatography (HPLC). The HPLC assay was shown to be stability indicating for epinephrine only. All the drugs in the LET solution had no more than a 5% reduction from initial concentration, according to the assay, when stored for 4 weeks in amber or glass containers at 4 or 18 degrees C and when stored for 26 weeks in amber containers at 4 degrees C. Solution stored in clear containers discolored more quickly than solution stored in amber containers. Epinephrine in an extemporaneously prepared LET solution was stable in amber glass bottles for 4 weeks at 18 degrees C and for 26 weeks at 4 degrees C.

Anesthetics, Local↗
PubMed1998

A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup.

BACKGROUND: In children with croup, treatment with nebulized budesonide decreases symptoms, but it is uncertain how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization. METHODS: We performed a double-blind, randomized trial involving 144 children with moderately severe croup. The children were treated with racepinephrine and a single dose of 4 mg of nebulized budesonide (48 children), 0.6 mg of intramuscular dexamethasone per kilogram of body weight (47 children), or placebo (49 children). The children were assessed before treatment and then hourly for five hours after treatment. Physicians who were unaware of the treatment assignments determined the children's need for further treatment and hospitalization. RESULTS: The characteristics of the groups were similar at base line, including the types of viruses identified, the types of croup, and the clinical severity of the illness. The overall rates of hospitalization were 71 percent in the placebo group (35 of 49 children), 38 percent in the budesonide group (18 of 48 children), and 23 percent in the dexamethasone group (11 of 47 children) (unadjusted P=0.001 for the comparison of budesonide with placebo, P<0.001 for the comparison of dexamethasone with placebo, and P=0.18 for the comparison of budesonide with dexamethasone). Children treated with budesonide or dexamethasone had a greater improvement in croup scores than those given placebo (P=0.03 and P<0.001, respectively), and those treated with dexamethasone had a greater improvement than those treated with budesonide (P=0.003). CONCLUSIONS: In children with moderately severe croup, treatment with intramuscular dexamethasone or nebulized budesonide resulted in more rapid clinical improvement than did the administration of placebo, with dexamethasone offering the greatest improvement. Treatment with either glucocorticoid resulted in fewer hospitalizations.

Administration, Inhalation↗
PubMed2000

Nebulized racemic epinephrine for extubation of newborn infants.

BACKGROUND: Following a period of mechanical ventilation, post-extubation upper airway obstruction can occur in newborn infants, especially after prolonged, traumatic or multiple intubations. The subsequent increase in upper airway resistance may lead to respiratory insufficiency and failure of extubation. The vasoconstrictive properties of epinephrine, and its proven efficacy in the treatment of croup in infants, has led to the routine use of inhaled nebulised epinephrine immediately post-extubation in some neonatal units. It is also recommended for neonates with post-extubation tracheal obstruction and stridor in neonatal and respiratory textbooks and reviews. OBJECTIVES: The primary objective was to assess whether nebulised epinephrine administered immediately after extubation in neonates weaned from IPPV decreases the need for subsequent additional respiratory support. SEARCH STRATEGY: Searches were made of Medline (MeSH search terms 'epinephrine' and 'exp infant, newborn'), the Oxford Database of Perinatal trials, expert informants and journal hand searching mainly in the English language, expert informant searches in the Japanese language by Prof. Ogawa, previous reviews including cross references, abstracts, and conference and symposia proceedings. SELECTION CRITERIA: All randomised and quasi-randomised control trials in which nebulised epinephrine was compared with placebo immediately post-extubation in newborn infants who have been weaned from IPPV and extubated, with regard to clinically important outcomes (i.e. need for additional respiratory support, increase in oxygen requirement, respiratory distress, stridor or the occurrence of side effects). DATA COLLECTION AND ANALYSIS: No studies met our criteria for inclusion in this review. MAIN RESULTS: No studies were identified which looked at the effect of inhaled nebulised epinephrine on clinically important outcomes in infants being extubated. REVIEWER'S CONCLUSIONS IMPLICATIONS FOR PRACTICE: There is no evidence either supporting or refuting the use of inhaled nebulised racemic epinephrine in newborn infants. IMPLICATIONS FOR RESEARCH: randomised controlled trials are needed comparing inhaled nebulised racemic epinephrine with placebo in neonates post-extubation. This should be looked at both as a routine treatment post-extubation and as specific treatment for post-extubation upper airway obstruction. Study populations should include the group of infants at highest risk for upper airway obstruction from mucosal swelling because of their small glottic and sub-glottic diameters (ie those infants with birthweights less than 1000 grams).

Administration, Inhalation↗
PubMed1975

Treatment of laryngotracheobronchitis (croup). Use of intermittent positive-pressure breathing and racemic epinephrine.

Use of racemic epinephrine hydrochloride (Vaponefrin), delivered by intermittent positive-pressure breathing, in the treatment of laryngotracheobronchitis (croup) produced acute beneficial results in a controlled study. However, symptoms often recurred within two hours, suggesting that this form of treatment should not be used in the emergency room and the patient then sent home. This treatment had no effect on arterial oxygen gas pressure. The changes in clinical status 24 to 36 hours after admission into the study were similar for the patients in the treatment and control groups, suggesting that the natural history of the disease was not drastically altered by this form of treatment.

Acute Disease↗
PubMed1978

Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study.

Racemic epinephrine has been advocated for the treatment of croup, but controlled studies have not proved it more effective than saline. Twenty patients (aged 4 months to 5 years) hospitalized with acute croup and persistent inspiratory stridor at rest were randomly assigned to one of two treatment groups: saline or racemic epinephrine, both nebulized and delivered by intermittent positive pressure breathing. Clinical scores were significantly improved (P less than .01) at ten and 30 minutes following the treatment with racemic epinephrine but not at 120 minutes. Racemic epinephrine was significantly more effective than saline at 10 (P less than .01) and 30 minutes (P less than .05) but not at 120 minutes after the treatment. We conclude that nebulized racemic epinephrine is effective treatment for the acute signs of croup.

Acute Disease↗
PubMed1989

Treatment of croup. A critical review.

Although viral croup is the most common form of airway obstruction in children 6 months to 6 years of age, there is debate regarding medical care for the hospitalized patient. A complete review of the English-language literature from 1960 to 1988 was performed, using both manual and Medline searches. Critical review shows that laryngotracheitis and spasmodic croup, previously emphasized in the literature as having distinct etiologies, most likely are two ends of a broad spectrum in the clinical presentation of a single disease. Critical assessment of all prospective randomized double-blind placebo-controlled trials reported during the study period shows that there is little information on the use of humidified air or supplemental oxygen, that racemic epinephrine hydrochloride is of well-demonstrated efficacy, and that dexamethasone phosphate at a dose greater than 0.3 mg/kg is effective in decreasing the length and severity of respiratory symptoms associated with viral croup.

Adrenal Cortex Hormones↗
PubMed1995

The clinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis.

OBJECTIVE: To investigate whether nebulized racemic epinephrine or albuterol improves respiratory distress in infants with acute bronchiolitis. DESIGN: A randomized, placebo-controlled, double-blind study. SETTING: A university hospital providing primary hospital care for all pediatric patients in a defined area. PATIENTS: One hundred consecutive infants younger than 24 months treated in the hospital for acute bronchiolitis. INTERVENTION: The patients received two inhalations at 30-minute intervals: racemic epinephrine followed by physiologic saline (REP group; n = 24), albuterol followed by physiologic saline (AP group; n = 27), physiologic saline followed by racemic epinephrine (PRE group; n = 24), and physiologic saline followed by albuterol (PA group; n = 25). All patients received intramuscular epinephrine 60 minutes after the beginning of the study. MAIN OUTCOME MEASURES: Oxygen saturation, respiratory rate, and two clinical scores were used: one based on wheezing and retractions (Respiratory Distress Assessment Instrument) and the other based on changes in wheezing, retractions, and respiratory rate (Respiratory Assessment Change Score). MAIN RESULTS: During the study, there were no significant differences among the four groups in clinical scores, oxygen saturations, and respiratory rates. Mean Respiratory Distress Assessment Instrument scores improved significantly within the REP, PRE, and AP groups 15 minutes after the first inhalation. In only the REP group, which received racemic epinephrine, the confidence limits did not overlap. A comparison of paired data of each patient revealed that the difference in Respiratory Assessment Change Score was significant between racemic epinephrine and physiologic saline, but not between albuterol and physiologic saline. Intramuscular epinephrine significantly improved Respiratory Distress Assessment Index scores in those groups treated earlier with racemic epinephrine (REP and PRE groups). No significant adverse effects were seen in any group or at any phase of the study. CONCLUSIONS: Elimination of hypoxia by supplemental oxygen and moistening of inspired air relieve the symptoms of acute bronchiolitis. Nebulized racemic epinephrine and albuterol are safe and useful in the treatment of acute bronchiolitis. Improvements in symptom scores at 15 minutes favor the use of racemic epinephrine. As the action of epinephrine is short, the effect can be increased by repeated inhalations.

Acute Disease↗
PubMed2001

Modeling and optimization of the chiral selectivity of basic analytes in chiral capillary electrophoresis with negatively charged cyclodextrins using electrochemical detection.

A mathematical model concerning the separation selectivity of basic analytes in chiral capillary electrophoresis (CE) modified with negatively charged cyclodextrins (CDs) has been presented to describe the dependence of chiral selectivity on the buffer pH and the chiral selector concentration. The electrophoretic method to determine the parameters of the model has also been developed. The model has been tested with racemic epinephrine and isoproterenol as target analytes and sulfonated beta-CD as chiral selector. The agreements have been found between the calculated and the measured values. Some significant conclusions to optimize chiral CE separation have been derived from the model and proven by the experiments. Electrochemical detection was used to meet the requirement of the low introduced concentration of analytes.

Cyclodextrins↗
PubMed1984

Clinical effectiveness of mechanical-chemical tissue displacement methods.

The following conclusions were made after statistical analysis. There was no significant difference between racemic epinephrine cord and aluminum sulfate cord. Both racemic epinephrine cord and aluminum sulfate cord were more effective than nonmedicated cord. There was no difference between dry cord and water-saturated cord. Hemorrhage control with a cord saturated in Hemodent was more effective than water-saturated or dry cords. The racemic epinephrine cord was not superior to the aluminum sulfate cord, so the dentist could eliminate a cord with potential systemic effects and substitute the more innocuous cord. Hemodent approximately doubled the hemostasis success of any cord used in this study.

Adolescent↗
PubMed1992

Racemic epinephrine use in croup and disposition.

The purpose of this study was to determine the effectiveness of a protocol for the outpatient management of laryngotracheitis (croup) using racemic epinephrine and steroids. The authors retrospectively reviewed fifty consecutive charts of children with croup who were treated under this protocol in the Scottish Rite Children's Medical Center Emergency Department (Atlanta, GA) and discharged to home after 2 hours of observation. Forty-seven of the 50 children had stridor at rest and/or retracting at rest on presentation to the emergency department. Forty-seven of the 50 patients did not require further medical care within 48 hours. One patient required another emergency visit and additional treatment with racemic epinephrine. Two patients were lost to follow-up. This study suggests that selected children presenting with croup and significant distress may be effectively treated with racemic epinephrine and steroids, observed for at least 2 hours, and safely discharged home.

Aerosols↗
PubMed1994

Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy?

The purpose of this study was to identify a cohort of children with laryngotracheitis (croup) who may be safely discharged from the emergency department (ED) after treatment with nebulized racemic epinephrine (RE), corticosteroids, and prolonged observation. Consecutive children (younger than 13 years of age) presenting to the ED with the diagnosis of laryngotracheitis were evaluated prospectively according to a croup scoring system. Sixty-one patients (4 to 108 months of age) with persistent inspiratory stridor at rest after 20 minutes of mist therapy who received nebulized RE (0.05) mL/kg of a 2.25% solution) and intramuscular dexamethasone (0.6 mg/kg) were enrolled in the study. Patients were observed in the ED while croup scores were assessed at 15, 60, 120, and 180 minutes. Croup scores were significantly improved (analysis of variance, P < .01) throughout the observation period in 31 patients (51%) who were discharged from the ED. Only one patient returned within 48 hours for further cool mist therapy. The maximum benefit from RE therapy was seen at 60 minutes. If a child had persistent resting stridor or a croup score greater than 2 at that time, hospitalization was inevitable. The 30 patients admitted to the hospital were younger (19.1 v 27.8 months) and had higher pretreatment croup scores (5.7 v 4.1). This was the first prospective study to identify a subset of children who have received RE to be safely discharged home after observation in the ED.

Administration, Inhalation↗
PubMed1983

Croup: pathogenesis and management.

Croup syndromes are common in children, most frequently being infectious in origin. Children present with a slow progression of inspiratory and expiratory stridor and a croupy, "barking seal" cough. Children are variably febrile and with progression of disease, exhaustion, agitation, cyanosis and air hunger may develop. The evaluation of the patient must focus on the degree of respiratory distress and associated findings. Epiglottitis and foreign body aspiration must be excluded. Management is primarily dependent upon administration of humidified air. Children with moderate to severe croup benefit from racemic epinephrine and steroids. Admission is indicated in children with stridor at rest, evidence of exhaustion, toxicity or respiratory distress. Active airway intervention is rarely required but may be life saving if obstruction develops.

Child↗
PubMed1993

Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infants with bronchiolitis.

To test the efficacy of a combined alpha- and beta-receptor agonist in acute bronchiolitis, we compared inhaled racemic epinephrine with salbutamol in a double-blind, crossover, randomized protocol. Twenty-four infants, 4.6 +/- 0.5 (mean +/- SEM) months of age, with their first episode of bronchiolitis were tested. After sedation with chloral hydrate, a clinical score and pulmonary mechanics measurements using simultaneous signals of airflow volume and transpulmonary pressure were recorded. After baseline measurements, infants received either nebulized salbutamol, 0.03 ml/kg, or racemic epinephrine, 0.1 ml/kg. Thirty minutes later, there was a significant decrease in clinical score after treatment with racemic epinephrine compared with the baseline score (p < 0.001); this difference was not present after salbutamol inhalation (p = 0.42). Only 13 patients had a decrease in clinical score after salbutamol therapy, in comparison with 20 infants treated with racemic epinephrine (p < 0.01). Both drug decreased respiratory rate, but the decrease was greater after the use of racemic epinephrine (p < 0.001). There was a significant decrease in inspiratory, expiratory, and total pulmonary resistance after treatment with racemic epinephrine compared with baseline values (p < 0.01) but no significant change after salbutamol inhalation. There was no significant correlation between the clinical score and pulmonary mechanics either at baseline or after drug treatment. We conclude that racemic epinephrine is superior to salbutamol in the treatment of infants with their first episode of acute bronchiolitis.

Administration, Inhalation↗
PubMed1989

A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis.

To determine whether a single dose of dexamethasone (0.6 mg/kg) is useful in the treatment of acute laryngotracheitis (croup), 29 hospitalized patients with acute laryngotracheitis were randomly assigned in a double-blind fashion to receive either parenterally administered dexamethasone (n = 16) or a saline placebo (n = 13). Severity of the illness was assessed by a clinical croup score based on retractions, stridor, air entry, cyanosis, and level of consciousness. Twelve hours from the time of injection, the patients receiving the dexamethasone had a statistically significant decline in median croup score from 4.5 to 1.0 (p less than 0.001), whereas the patients receiving the placebo did not. By 24 hours, a decline of two or more points in the total croup score was noted in 85% of the patients in the dexamethasone group compared with 33% of the patients in the placebo group (p = 0.027). During this same period, only 19% of patients receiving dexamethasone required two or more racemic epinephrine treatments in comparison with 62% of patients who received the placebo (p less than 0.05). There was no statistical difference between the two groups in improvement in oxygen saturation, respiratory rates, or duration of hospitalization. We conclude that dexamethasone is beneficial in reducing the overall severity of moderate to severe acute laryngotracheitis during the first 24 hours after injection.

Acute Disease↗