Pembimbing :

Sri Puspitasari, dr., Sp. An

Departemen Anestesiologi & Reanimasi
Fakultas kedokteran Universitas Airlangga/ RSUD Dr. Soetomo
Surabaya

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 Also known as Adrenaline
Epinephrine is a naturally occurring catecholamine
that is produced in the medulla of the adrenal glands
Prototype sympathomimetic drug.
acts as a hormone and neurotransmitter.

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Rescucitation
Drug Of Choice for treatment Cardiac Arrest
Its main action is to increase vascular resistance via alpha-1 receptor
vasoconstriction
Improves perfusion pressure to the myocardium and brain.
Dose :
When treating VF/VT cardiac arrest, 1mg is given once chest
compressions have restarted after the third shock and then every 3-5
minutes (alternate CPR cycles).
For PEA arrest 1 mg is given as soon as intravascular access is achieved,
and then every 3-5 minutes (alternate cycles).
Route Of Administration :
Intravenous
Tracheal drug administration is no longer recommended.

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Anaphylaxis
Drug of choice for the treatment of anaphylaxis.
As an alpha-1 agonist, it reverses the peripheral vasodilation caused by
inflammatory mediator release, and also reduces oedema.
Its beta-receptor activity dilates bronchial airways, increases
myocardial contractility, suppresses histamine and leukotriene release
and attenuates the severity of IgE-mediated allergic reactions.
Route of Administration :
Intramuscular (IM) at
Intravenous (IV) access and the use of IV adrenaline, it may be titrated
cautiously.

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Inotropic support

Epinephrine may only be administered as a continuous infusion in the

intensive Care Unit
Should only be administered via a central venous catheter with
invasive blood pressure monitoring.
The indications include : profoundly low blood pressure, shock, low
cardiac output states and status asthmaticus.
Dosage :
1 mg in 250 mL [4 mcg/mL]) and run at a rate of 220 mcg/min.
As an infution at the rate 0,01 0,1 mcg/Kg/min. (Drugs In Anesthesia and
Intensive Care, Oxford University Press)

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Airway Obstruction
Indications :
Severe Croup
Angio Oedema or Inflammation

Route : Nebulized
Mechanism of action :
to reduce the local inflammatory process
to provide local vasoconstriction,
Dosage :
The dose for children is 0.5 ml/kg of a 1:1000 solution
(maximum of 5 ml)
Placed undiluted into the chamber of the nebulizer.
If racemic adrenaline is used the dose is 0.05 ml/kg (maximum
1.5 ml) of 1% solution diluted to 4 ml with normal saline.

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Topical or local vasoconstriction

Local vasoconstricting action,

Epinephrine may be used as a topical application or combined
with a local anaesthetic to be infiltrated.
Benefits :
Prolongs local anaesthetic action,
Reducing bleeding for operations at the site of injection

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 Morgan & Mikhails Clinical Anesthesiology 5th ed. 2013
Stoelting Parmacology and Physiology in Anesthetic Practice 5th
ed. 2015
Smith & Aitkenheads Textbook Of Anesthesia 6th ed. 2013
Kinnear J, 2011. Adrenaline. Anesthesia Tutoial Of The Week. World
Federation Of Societiy Of Anesthesiologist : June 2011.

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