Adrenaline

Adrenaline - Both a- and B-adrenergic receptors are stimulated. Low doses tend to produce predominantly B-effects while higher doses tend to produce predominantly a-effects. Stimulation of B1-receptors in the heart increases the rate and force of contraction, resulting in an increase in cardiac output. Stimulation of a1-receptor causes peripheral vasoconstriction, which increases the systolic BP. Stimulation of B2-receptors causes bronchodilatation and vasodilatation in certain vascular beds (skeletal muscles). Consequently, total systemic resistance may actually fall, explaining the decrease in diastolic BP that is sometimes seen.

Uses:
Low cardiac output states
Bronchospasm
Cardiac arrest
Anaphylaxis

Contraindications:
Before adequate intravascular volume replacement

Administration
Low cardiac output states
Dose: 0.01–0.30 μg/kg/min IV infusion via a central vein
Titrate dose according to HR, BP, cardiac output, presence of ectopic beats and urine output
4 mg made up to 50 ml glucose 5%

Dosage chart (ml/h)

Weight (kg)	Dose (ug/kg/min)
	0.02	0.05	0.1	0.15	0.2
50	0.8	1.9	3.8	5.6	7.5
60	0.9	2.3	4.5	6.8	9.0
70	1.1	2.6	5.3	7.9	10.5
80	1.2	3.0	6.0	9.0	12
90	1.4	3.4	6.8	10.1	13.5
100	1.5	3.8	7.5	11.3	15.0
110	1.7	4.1	8.3	12.4	16.5
120	1.8	4.5	9.0	13.5	18.0

Bronchospasm
• 0.5–1 mg nebulised PRN
• 0.5–1 ml of 1:1000 (0.5–1 mg) made up to 5 ml with sodium chloride 0.9%

Cardiac arrest 
• IV bolus: 10 ml 1 in 10 000 solution (1 mg)
Anaphylaxis
• IV bolus: 0.5–1.0 ml 1 in 10 000 solution (50–100 μg), may be repeated PRN, according to BP

How not to use adrenaline:
In the absence of haemodynamic monitoring
Do not connect to CVP lumen used for monitoring pressure (surge of drug during flushing of line)
Incompatible with alkaline solutions,e.g.sodium bicarbonate, furosemide, phenytoin and enoximone

Adverse effects:
Arrhythmia
Tachycardia
Hypertension
Myocardial ischaemia
Increased lactate levels

Cautions:
Acute myocardial ischaemia or MI