From the Research
Nebulized adrenaline is contraindicated in patients with known hypersensitivity to epinephrine or its components, and caution is warranted in patients with cardiovascular disorders, including coronary artery disease, arrhythmias, or hypertension. When considering the use of nebulized adrenaline for respiratory distress, it is crucial to weigh the potential benefits against the risks, particularly in patients with certain underlying conditions.
- Patients with a history of hypersensitivity to epinephrine or its components should not receive nebulized adrenaline due to the risk of an allergic reaction.
- Caution is advised in patients with cardiovascular disease, as epinephrine can exacerbate conditions such as coronary artery disease, arrhythmias, or hypertension, as noted in a study discussing the therapeutic dilemmas of anaphylaxis in patients with cardiovascular disease 1.
- Additionally, patients taking monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants should be treated with caution, as these medications can potentiate the effects of epinephrine, leading to severe hypertension.
- Nebulized epinephrine is not the first-line treatment for asthma exacerbations; instead, beta-2 agonists like salbutamol are preferred.
- The administration of nebulized epinephrine, typically in a 1:1000 solution (0.5 mL/kg up to 5 mL), requires monitoring for tachycardia, hypertension, and tremors.
- The effects of nebulized epinephrine are temporary, lasting approximately 2-3 hours, which may necessitate repeated doses or additional interventions, particularly in conditions like croup or laryngeal edema, where it has been shown to be beneficial 2.
- It's also important to consider the potential for other medications, such as ipratropium bromide and salbutamol, to increase intraocular pressure and cause acute angle-closure glaucoma in susceptible patients, although this is more directly related to these specific bronchodilators rather than adrenaline 3.
- The use of epinephrine in anaphylaxis, including its administration via routes other than intramuscular injection, has been discussed, emphasizing its life-saving effects but also the need for careful consideration of its use in various clinical scenarios 4.