OBJECTIVEEpinephrine has a place in the treatment of pediatric cardiopulmonary arrest but has been controversy concerning its optimal dose. This meta-analysis aimed to seek for evidences of the effectiveness of different doses of epinephrine in children with cardiac arrest and to evaluate the effectiveness of high-dose versus standard-dose epinephrine in children with cardiac arrest.

METHODPublished papers on randomized controlled trials (RCTs) and prospective clinical controlled trials (CCTs) were electronically searched from MEDLINE (1966 to September 2006), EMBASE (1974 to June 2006), the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2006), CBM (1998 to 2006) and CNKI (1994 to 2006). We also had searched the related references and manual retrieval 10 professional academic journals about epinephrine treatment of pediatric cardiopulmonary arrest (1998 to 2006). The search strategy was made according to the collaborative review group search strategy. At first, we found 546 articles. Second, we excluded 474 of them through reading the title, abstract, excluding non-randomized, non-controlled trials and non-clinical studies. Finally, we identified 4 papers through searching for original articles and telephone contact with some of the authors after excluding 68 papers. Then we performed the meta-analysis by RevMan 4.2.7. For homogenous dichotomous data (P > or = 0.1, I(2) < or = 50%) we calculated fixed effects model, relative risk (RR), 95% confidence intervals (CI), For heterogeneity Dichotomous data (P < 0.1, I(2)>50%) we calculated random effects model, relative risk (RR) and 95% confidence intervals (CI).

RESULTFour trials involving 360 cases were included. The results of meta-analysis indicated that there were no statistical difference in recovery of spontaneous circulation [RR = 1.28, 95% CI (0.93, 1.77)]. Perondi, Patterson and Cheng xiuyong's study compared the rate of survival at 24 hours and showed statistical heterogeneity (P = 0.01, I(2) = 0.77). The random effects model indicated that there were no significant difference [RR = 1.40, 95% CI (0.43, 4.55)]. The sensitivity analysis showed that after deleting Perondi's group there were no statistical heterogeneity. Fixed effects model indicated that there were significant difference [RR = 2.50, 95% CI (1.52, 4.11)]. T When the rates of survival to hospital discharge were compared among the 4 studies, there was statistical heterogeneity (P = 0.07, I(2) = 0.58), the random effects model indicated that there were no statistical difference [RR = 1.78, 95% CI (0.42, 7.50)], There were no heterogeneity after Cheng Xiu-yong group was deleted.

CONCLUSIONHigher doses of epinephrine in children with cardiopulmonary arrest may not increase the rate of recovery of spontaneous circulation, the rate of survival at 24 hours, the rate of survival to hospital discharge and worsen the neurological outcomes. Adverse reactions is difficult to monitor and evaluate because of the current restrictions on medical technology.

Bronchodilator Agents ; toxicity ; Child ; Epinephrine ; toxicity ; Heart Arrest ; chemically induced ; mortality ; Humans ; Pediatrics ; Risk ; Treatment Outcome ; United States

Abstract: Suxamethonium chloride is a depolarizing muscle relaxant used in general anesthesia. In overdose, it causes adverse reactions such as bradycardia, arrhythmia, cardiac arrest, and death. The article reviews the progress on testing methods of suxamethonium chloride such as infrared spectroscopy, chemical color reaction, chemical titration, enzyme electrode, chromatography and mass spectrometry.
Anesthesia, General ; Arrhythmias, Cardiac/chemically induced* ; Biosensing Techniques ; Bradycardia/chemically induced* ; Chromatography ; Drug Overdose ; Heart Arrest/chemically induced* ; Humans ; Mass Spectrometry ; Neuromuscular Depolarizing Agents/analysis* ; Spectrophotometry, Infrared ; Succinylcholine/analysis*

BACKGROUNDLidocaine and ropivacaine are often combined in clinical practice to obtain a rapid onset and a prolonged duration of action. However, the systemic toxicity of their mixture at different concentrations is unclear. This study aimed to compare the systemic toxicity of the mixture of ropivacaine and lidocaine at different concentrations when administered intravenously in rats.

METHODSForty-eight male Wistar rats were randomly divided into 4 groups (n = 12 each): 0.5% ropivacaine (group I); 1.0% ropivacaine and 1.0% lidocaine mixture (group II); 1.0% ropivacaine and 2.0% lidocaine mixture (group III); and 1.0% lidocaine (group IV). Local anesthetics were infused at a constant rate until cardiac arrest. Electrocardiogram, electroencephalogram and arterial blood pressure were continuously monitored. The onset of toxic manifestations (seizure, dysrhythmia, and cardiac arrest) was recorded, and then the doses of local anesthetics were calculated. Arterial blood samples were drawn for the determination of local anesthetics concentrations by high-performance liquid chromatography.

RESULTSThe onset of dysrhythmia was later significantly in group IV than in group I, group II, and group III (P < 0.01), but there was no significant difference in these groups (P > 0.05). The onset of seizure, cardiac arrest in group I ((9.2 + or - 1.0) min, (37.0 + or - 3.0) min) was similar to that in group II ((9.1 + or - 0.9) min, (35.0 + or - 4.0) min) (P > 0.05), but both were later in group III ((7.5 + or - 0.7) min, (28.0 + or - 3.0) min) (P < 0.05). The onset of each toxic manifestation was significantly later in group IV than in group I (P < 0.01). The plasma concentrations of the lidocaine-alone group at the onset of dysrhythmia (DYS), cardiac arrest (CA) ((41.2 + or - 6.8) min, (59.0 + or - 9.0) min) were higher than those of the ropivacaine alone group ((20.5 + or - 3.8) min, (38.0 + or - 8.0) min) (P < 0.05). The plasma concentrations of ropivacaine inducing toxic manifestation were not significantly different among groups I, II, and III (P > 0.05).

CONCLUSIONSThe systemic toxicity of the mixture of 1.0% ropivacaine and 2.0% lidocaine is the greatest while that of 1.0% lidocaine is the least. However, the systemic toxicity of the mixture of 1.0% ropivacaine and 1.0% lidocaine is similar to that of 0.5% ropivacaine alone.

Amides ; toxicity ; Anesthetics, Local ; toxicity ; Animals ; Arrhythmias, Cardiac ; chemically induced ; Cardiovascular System ; drug effects ; Central Nervous System ; drug effects ; Heart Arrest ; chemically induced ; Lidocaine ; toxicity ; Male ; Random Allocation ; Rats ; Rats, Wistar ; Seizures ; chemically induced

Although levobupivacaine (LBUP) is less cardiotoxic than racemic bupivacaine (RBUP), the resuscitation from the LBUP-induced cardiovascular collapse (CVC) has not been easy as expected. Following the recent reports that proposed the resuscitative action of insulin for the RBUP-induced CVC, a controlled trial was performed to assess the feasibility of insulin for the LBUP-induced CVC. Fourteen dogs were randomly allocated into two groups: the RBUP and LBUP groups. Each group received continuous intravenous infusions of RBUP or LBUP until the mean arterial pressure (MAP) reached 40 mmHg. Then, an intravenous bolus of insulin (2 U/kg) was administered. Both groups were successfully resuscitated. At CVC, a decrease of cardiac output and an increase of systemic vascular resistance were observed but to a lesser degree in the LBUP group (p<0.05). After insulin injection, the MAP further declined to under 40 mmHg for several minutes, which was more protracted in the LBUP group (p<0.05). The CVCs induced by LBUP or RBUP in anesthetized dogs could be successfully resuscitated by insulin. Compared with RBUP, however, the less degree of vasoconstriction by LBUP and the innate vasodilatory property of insulin yielded a delayed increment of MAP during the immediate resuscitation period in the LBUP-induced CVC.
Treatment Outcome ; Overdose ; Male ; Insulin/*administration & dosage ; Heart Arrest/*chemically induced/physiopathology/*prevention & control ; Drug Combinations ; Dose-Response Relationship, Drug ; Dogs ; Cardiopulmonary Resuscitation/methods ; Cardiac Output/*drug effects ; Bupivacaine/*adverse effects/analogs & derivatives ; Blood Pressure/*drug effects ; Blood Flow Velocity/drug effects ; Animals ; Anesthetics, Local