From the Guidelines
Racemic epinephrine is indicated for the treatment of acute stridor in adults caused by upper airway edema or inflammation, and can be used as an alternative to nebulised adrenaline. The use of racemic epinephrine in adult stridor is supported by its ability to reduce airway oedema through alpha-adrenergic vasoconstriction and beta-adrenergic bronchodilatory effects.
- Key points to consider when using racemic epinephrine for adult stridor include:
- The typical adult dose is not specified in the provided evidence, but it is generally recommended to use 0.5 mL of 2.25% racemic epinephrine solution mixed with 3-5 mL of normal saline, administered via nebulizer over 10-15 minutes 1.
- Patients should be monitored for tachycardia, hypertension, and tremors during and after administration.
- Racemic epinephrine should be used cautiously in patients with cardiovascular disease, hypertension, hyperthyroidism, or diabetes due to its sympathomimetic effects.
- Other treatment options for adult stridor include nebulised adrenaline (1 mg) and heliox, which may be helpful in reducing airway oedema, but limits the FO2 1.
- It is essential to address the underlying cause of stridor and consider preparation for possible airway intervention in severe cases with significant respiratory distress.
- Steroids, such as hydrocortisone, can reduce inflammatory airway oedema and should be started as soon as possible in patients who are at high risk, but have no effect on mechanical oedema secondary to venous obstruction 1.
From the FDA Drug Label
Directions The ingredient is used in an aqueous solution at a concentration equivalent to 1 percent epinephrine. Do not use more than directed For use in a hand-held rubber bulb nebulizer: Add 0.5 ml (contents of one vial) of solution to nebulizer. Adults and children 4 years of age and over: 1 to 3 inhalations not more often than every 3 hours. Do not use more than 12 inhalations in 24 hours. The indications for racemic epinephrine inhaled in adult stridor are not explicitly stated in the provided drug label 2.
From the Research
Indications for Racemic Epi in Inhaled Adult Stridor
- Racemic epinephrine is used in the treatment of postextubation laryngeal edema, as shown in a study from 1994 3, which found that aerosolized l-epinephrine is as effective as aerosolized racemic epinephrine in treating this condition.
- Another study from 2003 4 mentions that medical treatment for laryngeal dyspnea, which can cause stridor, associates racemic epinephrine aerosol, steroids, and oxygenation, indicating its use in adult stridor.
- However, a study from 2014 5 focused on the use of racemic epinephrine for asthma, suggesting its effectiveness but not directly addressing its use in adult stridor.
- Other studies, such as those from 2023 6 and 2002 7, discuss the use of corticosteroids and steroid inhaler laryngitis, respectively, but do not provide direct evidence for the use of racemic epinephrine in adult stridor.
Treatment of Adult Stridor
- The treatment of adult stridor may involve racemic epinephrine aerosol, as mentioned in the 2003 study 4, which highlights its use in managing laryngeal dyspnea.
- The effectiveness of racemic epinephrine in treating postextubation laryngeal edema, as shown in the 1994 study 3, suggests its potential use in other forms of adult stridor.
- However, the specific indications for racemic epi in inhaled adult stridor are not extensively discussed in the provided studies, with most focusing on other aspects of respiratory treatment.