1.
Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review.
Wiebe, K, Rowe, BH
CJEM. 2007;(4):304-8
Abstract
Acute asthma is a common emergency department (ED) problem that is typically treated with bronchodilators and anti-inflammatories. Nebulized selective, short-acting beta-agonists, such as salbutamol, are the bronchodilators of choice in most Canadian EDs. Other important treatments in moderate-to-severe cases include systemic corticosteroids and in severe cases may include the addition of ipratropium bromide and magnesium sulfate. Despite aggressive management, some patients do not respond adequately to nebulized salbutamol. Treatment options in these patients are limited to interventions such as parenteral epinephrine, and non-invasive and mechanical ventilation (or both). Both parenteral epinephrine and mechanical ventilation have associated risks, so alternative treatments with a lower risk profile would be useful for the treatment of life-threatening asthma. The following case report describes a patient in whom nebulized racemic epinephrine was used successfully to treat severe acute asthma following failure of standard first-line therapies.
2.
Intraoperative administration of nitric oxide.
Dietrich, CC, Tobias, JD
Journal of intensive care medicine. 2003;(3):146-9
Abstract
Despite its therapeutic efficacy in various clinical scenarios in the intensive care unit setting, there are limited reports regarding the intraoperative applications of nitric oxide (NO). The authors present 2 pediatric patients to whom inhaled NO was administered intraoperatively. In one patient, NO was used to treat hypoxemia that developed after the institution of one-lung ventilation during thoracoscopic resection of a bronchiectatic section of lung. In the second patient, NO was used to alleviate pulmonary hypertension and cardiovascular dysfunction with pulmonary artery cross-clamping for placement of a modified Blalock-Taussig shunt. The potential intraoperative applications and techniques for the intraoperative delivery of NO are presented.