A potential association between myocardial ischemia and epinephrine for anaphylaxis

Urushidani, Seigo; Kuriyama, Akira

doi:10.1016/j.ajem.2020.01.033

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…[ 6 , 7 ] However, adrenaline may reduce coronary blood flow by inducing coronary vasoconstriction, increase myocardial oxygen consumption by increasing the heart rate and cardiac contractility due to the β1-receptor effect, and induce myocardial ischemia even in patients with anaphylactic shock who are originally at low risk of myocardial ischemia. [ 8 ] Adrenaline administration in patients with aortic stenosis is even more likely to cause myocardial oxygen supply–demand imbalance. [ 9 ] In patients with aortic stenosis or hypertrophic cardiomyopathy, improperly managed anaphylactic shock can lead to circulatory collapse and necessitate extracorporeal membrane oxygenation, [ 10 , 11 ] although there are no definitive guidelines regarding the use of adrenaline in such patients.…”

Section: Discussionmentioning

confidence: 99%

“…Adrenaline administration is an essential treatment for anaphylactic shock due to its strong α- and β-receptor-stimulating effects and an inhibitory effect on histamine release and other anaphylactic mediators [6,7] . However, adrenaline may reduce coronary blood flow by inducing coronary vasoconstriction, increase myocardial oxygen consumption by increasing the heart rate and cardiac contractility due to the β1-receptor effect, and induce myocardial ischemia even in patients with anaphylactic shock who are originally at low risk of myocardial ischemia [8] . Adrenaline administration in patients with aortic stenosis is even more likely to cause myocardial oxygen supply–demand imbalance [9] .…”

Section: Discussionmentioning

confidence: 99%

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Anaphylactic shock in a patient with severe aortic stenosis treated with adrenaline and landiolol for circulatory management

et al. 2021

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Rationale: We present the first case of a patient with severe aortic stenosis who developed anaphylactic shock and was successfully treated with adrenaline and landiolol, a highly selective β1-receptor blocker, to prevent disruption of the myocardial oxygen supply–demand balance caused by tachycardia. Patient concerns: An 86-year-old woman was scheduled for simultaneous anterior–posterior fixation for a burst fracture of the 12th thoracic vertebra; 200 mg sugammadex, a neuromuscular blocking agent antagonist, was administered postoperatively, and she was extubated without complications. However, 6 min after extubation, her blood pressure decreased abruptly to 55/29 mm Hg, and her heart rate increased to 78 bpm. Then, we intervened with fluid loading, an increased dose of noradrenaline, and phenylephrine administration. However, her blood pressure did not increase. Diagnoses: A general observation revealed urticaria on the lower leg; thus, we suspected anaphylactic shock due to sugammadex administration. Interventions: We carefully administered 2 doses of 0.05 mg adrenaline and simultaneously administered landiolol at 60 μg/kg/min to suppress adrenaline-induced tachycardia. Adrenaline administration resulted in a rapid increase in blood pressure to 103/66 mm Hg and a maximum heart rate of 100 bpm, suppressing excessive tachycardia. Outcomes: The patient's general condition was stable after the intervention, and circulatory agonists could be discontinued the following day. She was discharged from the intensive care unit on the fourth postoperative day. Lessons: Landiolol may help control the heart rate of patients with aortic stenosis and anaphylactic shock. The combined use of landiolol and adrenaline may improve patient outcomes; however, their efficacy and risks must be evaluated by studying additional cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anaphylactic shock in a patient with severe aortic stenosis treated with adrenaline and landiolol for circulatory management

et al. 2021

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“…Meanwhile, adrenaline can decrease coronary blood flow through coronary artery vasoconstriction, increase myocardial oxygen demand, and exacerbate myocardial ischemia [ 12 ]. Accordingly, adrenaline administration may increase the risk of myocardial ischemia in patients with coronary artery stenosis or myocardial hypertrophy, and hence, it should be administered cautiously even during anaphylaxis treatment [ 13 ]. In our patient, adrenaline was administered in parallel as bolus and continuous infusion.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of severe adrenaline-resistant anaphylactic shock with glucagon in a patient taking a beta-blocker: a case report

et al. 2021

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Background The efficacy of glucagon for adrenaline-resistant anaphylactic shock in patients taking β-blockers is controversial. However, understanding the efficacy of glucagon is important because adrenaline-resistant anaphylactic shock is fatal. We present a case of severe adrenaline-resistant anaphylactic shock in a patient taking a β-blocker, and glucagon was effective in improving hemodynamics. Case presentation An 88-year-old woman with severe aortic stenosis and taking a selective β-1 blocker underwent transcatheter aortic valve implantation under general anesthesia. Postoperatively, she received 100 mg sugammadex, but 2 min later developed severe hypotension and bronchospasm. Suspecting anaphylactic shock, we intervened by administering adrenaline, fluid loading, and an increased noradrenaline dose. Consequently, the bronchospasm improved, but her blood pressure only increased minimally. Therefore, we administered 1 mg glucagon intravenously, and the hypotension resolved immediately. Conclusions Glucagon may improve hemodynamics in adrenaline-resistant anaphylactic shock patients taking β-blockers; however, its efficacy must be further evaluated in more cases.

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“…Two patients in our study were admitted under these conditions, and another patient had suspected epinephrine-induced ACS. There is a risk of myocardial ischemia after the treatment of anaphylaxis, especially following epinephrine administration [ 38 ]. The only patient who required admission in the Formicidae group had underdiagnosed ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

Lin

Chiu

Chang

et al. 2020

IJERPH

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Background: Hymenopteran stings are the most common animal insult injury encountered in the emergency department. With increasing global spread of imported fire ants in recent decades, the rate of Formicidae assault has become a serious problem in many countries. Formicidae-associated injuries gradually increased in Taiwan in recent decades and became the second most common arthropod assault injury in our ED. The present study aimed at comparing the clinical characteristics of Formicidae sting patients with those of the most serious and common group, Vespidae sting patients, in an emergency department (ED) in Taiwan. Methods: This retrospective study included patients who were admitted between 2015 to 2018 to the ED in a local teaching hospital in Taiwan after a Vespidae or Formicidae sting. Cases with anaphylactic reaction were further compared. Results: We reviewed the records of 881 subjects (503 males, 378 females; mean age, 49.09 ± 17.62 years) who visited our emergency department due to Vespidae or Formicidae stings. A total of 538 (61.1%) were categorized into the Vespidae group, and 343 (38.9%) were sorted into the Formicidae group. The Formicidae group had a longer ED length of stay (79.15 ± 92.30 vs. 108.00 ± 96.50 min, p < 0.01), but the Vespidae group had more cases that required hospitalization (1.9% vs. 0.3%, p = 0.04). Antihistamines (76.8% vs. 80.2%, p < 0.01) were more frequently used in the Formicidae group, while analgesics were more frequently used in the Vespidae group (38.1% vs. 12.5%, p < 0.01). The Vespidae group had more local reactions, and the Formicidae group had more extreme, systemic, or anaphylactic allergic reactions. Creatine kinase was significantly higher in the Vespidae group with an anaphylactic reaction. Sting frequency in both groups exhibited the same positive associations with average temperature of the month and weekend days. Conclusion: Formicidae sting patients presented to the ED with higher rate allergic reactions and spent more time in the ED than Vespidae sting patients. However, Vespidae sting patients had more complications and higher rates of admission, especially with anaphylactic reaction. Laboratory data, especially creatine kinase data, were more valuable to check in Vespidae sting patients with an anaphylactic reaction in the ED. Both groups exhibited positive correlations with temperature and a higher rate on weekend days.

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A potential association between myocardial ischemia and epinephrine for anaphylaxis

Cited by 10 publications

References 14 publications

Anaphylactic shock in a patient with severe aortic stenosis treated with adrenaline and landiolol for circulatory management

Anaphylactic shock in a patient with severe aortic stenosis treated with adrenaline and landiolol for circulatory management

Successful treatment of severe adrenaline-resistant anaphylactic shock with glucagon in a patient taking a beta-blocker: a case report

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

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