Farmacoriflessioni
Adrenalina, il farmaco salvavita
Epinephrine, a life-saving drug
Cristina Tumminelli1, Domenica Squillaci1, Lorenzo Calligaris2, Irene Berti2, Federico Poropat2, Egidio Barbi1,2, Alessandro Amaddeo2, Giorgio Cozzi2
1Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Marzo 2023 - pagg. 169 -176 | DOI: 10.53126/MEB42169
Abstract
The administration of epinephrine is recommended in children with severe clinical conditions, such as in case of anaphylaxis, life-threatening asthma, shock and cardiac arrest. Due to the very low frequency of these conditions in common paediatric emergency settings in Italy, paediatricians may be unfamiliar with the use of this fundamental drug. This article presents the indications and ways of administration of epinephrine in the clinical contest in which is required, according to the current guidelines.
Riassunto
La somministrazione di epinefrina è raccomandata nei bambini con gravi condizioni cliniche, come in caso di anafilassi, asma potenzialmente letale, shock e arresto cardiaco. A causa della bassissima frequenza di queste condizioni nelle comuni emergenze pediatriche in Italia, i pediatri potrebbero non avere familiarità con l'uso di questo fondamentale farmaco. In questo articolo vengono presentate le indicazioni e le modalità di somministrazione dell'epinefrina nel contesto clinico in cui è richiesta, secondo le attuali linee guida.
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Classificazione MeSH
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Bibliografia
1. Squillaci D, Tumminelli C, Molina Ruiz I, et al. Terapia farmacologica in urgenza. Medico e Bambino 2022;41(7):441-50. doi: 10.53126/MEB41441.
2. Longo G, Bradaschia F. Adrenalina: tante vie per tante indicazioni. Medico e Bambino 1997;16(1):17-21.
3. Simons FE, Roberts JR, Gu X, Simons KJ. Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol 1998;101(1 Pt 1):33-7. doi: 10.1016/S0091-6749(98)70190-3.
4. Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract 2015; 3(1):76-80. doi: 10.1016/j.jaip.2014.06.007.
5. Marchetti F, Salierno P. La terapia del croup. Medico e Bambino 2007;26(4):242-8.
6. Marchetti F. Il trattamento del croup, tra conformismo e pratica clinica. Medico e Bambino pagine elettroniche 2008;11(5).
7. Amir L, Hubermann H, Halevi A, Mor M, Mimouni M, Waisman Y. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care 2006;22(8):541-4. doi: 10. 1097/01.pec.0000230552.63799.32.
8. Bjornson C, Russell K, Vandermeer B, et al. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev 2011;(2): CD006619. doi: 10.1002/14651858.CD006619. pub2.
9. Vieni G, Genovese MR, Biserna L, Graziani G, Berti I, Marchetti F. Anafilassi: miti, fatti e controversie. Medico e Bambino 2019;38 (3):154-60.
10. Badina L. Anafilassi: tra miti e realtà. Medico e Bambino 2019;38(3):161-2.
11. Muraro A, Roberts G, Halken S, et al. EAACI guidelines on allergen immunotherapy: Executive statement. Allergy 2018;73 (4):739-43. doi: 10.1111/all.13420.
12. Simons FE, Ardusso LR, Biḷ MB, et al. International Consensus on (ICON) anaphylaxis. World Allergy Organ J 2014;7(1):9. doi: 10.1186/1939-4551-7-9.
13. Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus sub-cutaneous injection. J Allergy Clin Immunol 2001;108(5):871-3. doi: 10.1067/mai.2001. 119409.
14. Korenblat P, Lundie MJ, Dankner RE, Day JH. A retrospective study of epinephrine administration for anaphylaxis: how many doses are needed? Allergy Asthma Proc 1999;20(6): 383-6. doi: 10.2500/108854199778251834.
15. Campbell RL, Bashore CJ, Lee S, et al. Predictors of repeat epinephrine administration for emergency department patients with anaphylaxis. J Allergy Clin Immunol Pract 2015;3(4):576-84. doi: 10.1016/j.jaip.2015.04. 009.
16. Rachid O, Simons FE, Wein MB, et al. Epinephrine doses contained in outdated epinephrine auto-injectors collected in a Florida allergy practice. Ann Allergy Asthma Immunol 2015;114(4):354-6. doi: 10.1016/j.anai. 2015.01.015.
17. Bradaschia F, Longo G. L’adrenalina e la valigetta del medico. Medico e Bambino 2002;21(1):46.
18. Longo G, Maschio M, Panontin E, Marchetti F, Furcolo G, Quarantiello F. La gestione dell’accesso asmatico acuto in Pronto Soccorso (e non solo). Medico e Bambino 2014; 33(9):563-9.
19. Turpeinen M, Kuokkanen J, Backman A. Adrenaline and nebulized salbutamol in acute asthma. Arch Dis Child 1984;59(7):666-8. doi: 10.1136/adc.59.7.666.
20. Becker AB, Nelson NA, Simons FE. Inhaled salbutamol (albuterol) vs injected epinephrine in the treatment of acute asthma in children. J Pediatr 1983;102(3):465-9. doi: 10.1016/s0022-3476(83)80679-9.
21. Topjian AA, Raymond TT, Atkins D, et al. Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020;142(16_suppl_2): S469-S523. doi: 10.1161/CIR.0000000000000 901.
22. Andersen LW, Berg KM, Saindon BZ, et al. Time to epinephrine and survival after pediatric in-hospital cardiac arrest. JAMA 2015;314:802. doi: 10.1001/jama.2015.9678.
23. Hansen M, Schmicker RH, Newgard CD, et al. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults. Circulation 2018;137:2032. doi: 10.1161/CIRCULATIONAHA.117.033067.
24. Mangrum JM, DiMarco JP. The evaluation and management of bradycardia. N Engl J Med 2000;342:703. doi: 10.1056/NEJM 200003093421006.
25. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: pediatric advanced life sup-port: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S876-908. doi: 10.1161/ CIRCULATIONAHA.110.971101.
26. Dellinger RP, Levy MM, Rhodes A, et al.; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41 (2):580-637. doi: 10.1097/CCM.0b013e31827 e83af.
Corrispondenza: giorgio.cozzi@burlo.trieste.it