Intra-tracheal adrenaline.

result in the catheter and needle hitting the dura at different points. This would explain the low incidence of subarachnoid catheterization when the needle is not turned. of four subarachnoid solutions in a needle through needle technique for elective Caesarean section. Single space combined spinal-extradural technique for analgesia during labour. Sir,—McCrirrick and Monk [1] provided interesting data on the effect of adrenaline given by the i.v. and tracheal routes in the beating heart after coronary artery bypass surgery. However, to draw the conclusion that if tracheal adrenaline has little effect on the circulation in the spontaneously beating heart it therefore has little effect in the arrested heart, is clearly not justified. In doing so, they propose that the European Resuscitation Council should abandon its recommendation to give intra-tracheal adrenaline to patients with cardiac arrest if a vein cannot be cannulated [2]. It may be true that intra-tracheal adrenaline is ineffective in some patients with cardiac arrest, but this is not proven in this particular study. Other drugs such as lignocaine [2, 3] have been shown to be effective when administered by the tracheal route in cardiac arrest. There are mixed clinical experiences with adrenaline, possibly because it causes local pulmonary vaso-constriction and impedes its own absorption into the circulation. The dose administered via the tracheal tube must be higher than the i.v. dose [4-7]. If i.v. access is impossible in cardiac arrest, the use of intra-tracheal adrenaline is really a last resort. While there is anecdotal evidence of success in a number of patients, it is not justified to abandon the guidelines of the European Resuscitation Council until the case for or against is definitely proven. Intra-tracheal adrenaline does no harm and there is nothing to lose in a desperate situation. Further human studies are required in patients with cardiac arrest, but logistically this is likely to prove very difficult.tracheal and endobronchial lidocaine administration: effects on plasma lidocaine concentration and blood gases. Endotracheal versus intravenous epinephnne during elec-tromechanical dissociation with CPR in dogs. Intrapulmonary epinephrine during prolonged cardiopulmonary resuscitation: improved regional blood flow and resuscitation in dogs. Sir,—The primary action of adrenaline used for resuscitation is on alpha receptors [1,2], increasing systemic vascular resistance and coronary artery perfusion pressure. We believe there is no logic in an argument which suggests that intra-tracheal adrenaline may be more vasoactive at cardiac arrest than when the heart is still beating. In addition, uptake …