The feasibility of vasopressin administration via laryngeal mask airway using a porcine model
1Emergency Department, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
2Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
3Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
4Department of Environmental and Occupational Health, Medical College, National Cheng Kung University, Tainan, Taiwan
5Emergency Department, Taipei Medical University, Taipei, Taiwan
DOI: 10.22514/SV111.052016.10 Vol.11,Issue 1,May 2016 pp.142-156
Published: 02 May 2016
Background. In pre-hospital situations, delay in resuscitation might carry extra risks for patients, so resuscitative measures should be rapid, easy-to use, and effective. A laryngeal mask airway (LMA) is a quickly placed supraglottic airway that may be used as a route for drug administration. Vasopressin is a vasopressor and might be absorbed well via the mucosa of the airways and alveoli. We conducted this animal study to verify the feasibility of administering vasopressin via a LMA.
Methods. Twenty-four Yorkshire pigs were anesthetized and randomly divided into four groups. The pigs in Groups Placebo and tracheal tube (TT) were intubated with a cuffed tracheal tube, and those in Groups LMA and laryngeal mask airway and a catheter (LMAC) underwent a size 4 LMA insertion. In the LMAC group, an aerosolized catheter was placed into the trachea through a LMA to deliver the drug. All pigs were able to breathe spontaneously without the assistance of a ventilator. The placebo group received 5 ml of distilled water via a tracheal tube. The other groups received 1 U/kg vasopressin, which was diluted to a total volume of 5 ml with distilled water via the varied routes. The heart rates and arterial pressures were recorded before and after drug administration.
Results. The mean arterial pressure (MAP) and diastolic arterial pressure (DAP) increased significantly and maintained a plateau from 3 to 7 min in Group TT and 2 to 29 min in Group LMAC. Group LMA and Group Placebo demonstrated only one occasional elevation in MAP and no changes in DAP. Furthermore, the heart rate decreased significantly from 2 to 29 min in Group LMAC.
Conclusions. In this porcine model, vasopressin administered via an aerosolized catheter and ventilated with a LMA demonstrated a positive and prolonged pressor effect. The results suggest that an aerosolized catheter placed through a LMA, may be a practical alternative route for vasopressin administration, and that the effective duration of vasopressin is long enough to cover the period of pre-hospital management.
laryngeal mask airway, vasopressin, airway, pre-hospital
YU-YING LIAO,CHIEN-CHIN HSU,HOW-RAN GUO,KUO-TAI CHEN. The feasibility of vasopressin administration via laryngeal mask airway using a porcine model. Signa Vitae. 2016. 11(1);142-156.
1. Smith RM, Conn AK. Prehospital care – scoop and run or stay and play?Injury 2009;40: suppl 4S:23-6.
2. Liberman M, Mulder D, Lavoie A, Denis R, Sampalis JS. Multicenter Canadian study of prehospital trauma care. Ann Surg 2003;237:153-60.
3. Bochicchio GV, Scalea TM. Is field intubation useful? Curr Opin Crit Care 2003;9:524-9.
4. Isenberg DL, Bissell R. Does advanced life support provide benefits to patients?: A literature review. Prehosp Disaster Med 2005;20:265-70.
5. Reades R, Studnek JR, Vandeventer S, Garrett J. Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a randomized controlled trial. Ann Emerg Med 2011;58:509-16.
6. Pollack CV Jr. The laryngeal mask airway: a comprehensive review for the Emergency Physician. J Emerg Med 2001;20:53-66.
7. Ostermayer DG, Gausche-Hill M. Supraglottic Airways: The History and Current State of Prehospital Airway Adjuncts. Prehosp Emerg Care 2013 Sep 12. [Epub ahead of print]
8. Chen KT, Lin HJ, Guo HR, Lin MT, Lin CC. Feasibility study of epinephrine administration via laryngeal mask airway using a porcine model. Resuscitation 2006;69:503-7.
9. Chen KT, Lin HJ, Jeng HW, Lin CC, Guo HR. The pharmacological effect of epinephrine administration via laryngeal mask airway in a porcine model of asphyxial cardiac arrest. Emerg Med J 2008;25:722-4.
10. Liao CK, Lin HJ, Foo NP, Lin CC, Guo HR, Chen KT. Epinephrine administration via a laryngeal mask airway: what is the optimal dose?Signa Vitae 2010;5:25-8.
11. Raedler C, Voelckel WG, Wenzel V, Krismer AC, Schmittinger CA, Herff H, et al. Treatment of uncontrolled hemorrhagic shock after liver trauma: fatal effects of fluid resuscitation versus improved outcome after vasopressin. Anesth Analg 2004;98:1759-66.
12. Bayram B, Hocaoglu N, Atilla R, Kalkan S. Effects of terlipressin in a rat model of severe uncontrolled hemorrhage via liver injury. Am J Emerg Med 2012;30:1176-82.
13. Rezende-Neto JB, Rizoli SB, Andrade MV, Ribeiro DD, Lisboa TA, Camargos ER, et al. Permissive hypotension and desmopressin enhance clot formation. J Trauma 2010;68:42-50.
14. Holmes CL, Patel BM, Russell JA, Walley KR. Physiology of vasopressin relevant to management of septic shock. Chest 2001;120:989-1002.
15. Patel BM, Chittock DR, Russell JA, Walley KR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002;96:576-82.
16. Serpa Neto A, Nassar AP Júnior, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, et al. Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials. Crit Care 2012 Aug 14;16(4):R154.
17. Lange M, Ertmer C, Rehberg S, Morelli A, Köhler G, Kampmeier TG, et al. Effects of two different dosing regimens of terlipressin on organ functions in ovine endotoxemia. Inflamm Res 2011;60:429-37.
18. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3): S729-67.
19. Morris DC, Dereczyk BE, Grzybowski M, Martin GB, Rivers EP, Wortsman J, Amico JA. Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med 1997;4:878-83.
20. Dudkiewicz M, Proctor KG. Tissue oxygenation during management of cerebral perfusion pressure with phenylephrine or vasopressin. Crit Care Med 2008;36:2641-50.
21. Krismer AC, Wenzel V, Stadlbauer KH, Mayr VD, Lienhart HG, Arntz HR, Lindner KH. Vasopressin during cardiopulmonary resuscitation: a progress report. Crit Care Med 2004;32(9 Suppl):S432-5.
22. Jolly S, Newton G, Horlick E, Seidelin PH, Ross HJ, Husain M, Dzavik V. Effect of vasopressin on hemodynamics in patients with refractory cardiogenic shock complicating acute myocardial infarction. Am J Cardiol 2005;96:1617-20.
23. Efrati O, Barak A, Ben-Abraham R, Modan-Moses D, Berkovitch M, Manisterski Y, et al. Should vasopressin replace adrenaline for endotracheal drug administration? Crit Care Med 2003;31:572-6.
24. Efrati O, Barak A, Ben-Abraham R, Weinbroum AA, Lotan D, Manistersky Y, et al. Hemodynamic effects of tracheal administration of vasopressin in dogs. Resuscitation 2001;50:227-32.
25. Lin PC, Lin HJ, Guo HR, Lin CC, Chen KT. A comparison of the hemodynamic effects of tracheal administration of vasopressin, adrenaline, and vasopressin plus adrenaline in a porcine model. J Acute Med 2012;2:103-6.
26. Keller C, Puhringer F, Brimacombe JR. Influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth 1998;81:186-7.
27. Liao CK, Lin HJ, Chen KT. An easy method to administer drugs into the trachea via the intubating laryngeal mask airway. Am J Emerg Med 2008 Mar;26(3):370-1.
28. Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331:1105-9.
29. Revell M, Greaves I, Porter K. Endpoints for fluid resuscitation in hemorrhagic shock. J Trauma 2003;54(5 Suppl): S63-7.
30. Spaite DW, Bobrow BJ, Vadeboncoeur TF, Chikani V, Clark L, Mullins T, Sanders AB. Resuscitation 2008 Oct;79(1):61-6.
31. Spaite DW, Stiell IG, Bobrow BJ, de Boer M, Maloney J, Denninghoff K, et al. Ann Emerg Med 2009 Aug;54(2):248-55.
32. Richard C. Stress-related cardiomyopathies. Ann Intensive Care
33. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J 2012;33:895-903.
34. Efrati O, Modan-Moses D, Ben-Abraham R, Bibi H, Paret G. Atropine aborts bradycardic effect of endotracheally administered vasopressin. Med Sci Monit 2005;11: CR410-4.
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