PMID- 17163334
OWN - NLM
STAT- MEDLINE
DCOM- 20070221
LR  - 20220409
IS  - 0013-726X (Print)
IS  - 0013-726X (Linking)
VI  - 38
IP  - 12
DP  - 2006 Dec
TI  - Hemodynamics after endoscopic submucosal injection of epinephrine in patients 
      with nonvariceal upper gastrointestinal bleeding: a matter of concern.
PG  - 1284-8
AB  - We report about detailed hemodynamic changes and one major cardiac complication 
      occurring after submucosal injection of epinephrine (1 : 10 000) for management 
      of upper gastrointestinal bleeding in a series of four consecutive patients. 
      Cardiac contractility and afterload, determined by the cardiac index and the 
      systemic vascular resistence index (SVRI), were assessed by transpulmonary 
      thermodilution using the Pulse Contour Cardiac Output monitoring system (PiCCO; 
      Pulsion Medical Systems, Munich, Germany), and the mean arterial pressure and 
      heart rate were recorded. We observed a distinct rise in both mean arterial 
      pressure and heart rate, and this effect was pronounced in the three patients 
      with esophageal lesions. The increase in the mean arterial pressure was caused by 
      an elevation of the cardiac index in two patients, a rise in both cardiac index 
      and SVRI in one patient, and a rise in the SVRI only in the fourth patient. One 
      patient, who had received 30 ml epinephrine for treatment of a bleeding 
      Mallory-Weiss tear, developed an acute myocardial infarction during the 
      postprocedural follow-up period. In conclusion, submucosal injection of 
      epinephrine may cause significant hemodynamic changes that can potentially lead 
      to adverse cardiac events. Close cardiac monitoring during and after submucosal 
      application of epinephrine therefore seems a prudent precaution. In the treatment 
      of esophageal lesions, the total amount of epinephrine injected should be 
      carefully titrated, so that the lowest possible volume that achieves adequate 
      hemostasis is used.
FAU - von Delius, S
AU  - von Delius S
AD  - Department of Internal Medicine II, Technical University of Munich, Klinikum 
      Rechts der Isar, Munich, Germany. stefan_ruckert@yahoo.de
FAU - Thies, P
AU  - Thies P
FAU - Umgelter, A
AU  - Umgelter A
FAU - Prinz, C
AU  - Prinz C
FAU - Schmid, R M
AU  - Schmid RM
FAU - Huber, W
AU  - Huber W
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Endoscopy
JT  - Endoscopy
JID - 0215166
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Blood Pressure/drug effects
MH  - Electrocardiography
MH  - Endoscopy, Gastrointestinal/*methods
MH  - Epinephrine/*administration & dosage/adverse effects/pharmacology/*therapeutic 
      use
MH  - Esophageal and Gastric Varices/*drug therapy
MH  - Gastrointestinal Hemorrhage/*drug therapy/physiopathology
MH  - *Heart Rate/drug effects
MH  - Humans
MH  - Injections
MH  - Male
MH  - Middle Aged
MH  - Mucous Membrane/drug effects
MH  - Myocardium/enzymology
MH  - Vascular Resistance/drug effects
EDAT- 2006/12/14 09:00
MHDA- 2007/02/22 09:00
CRDT- 2006/12/14 09:00
PHST- 2006/12/14 09:00 [pubmed]
PHST- 2007/02/22 09:00 [medline]
PHST- 2006/12/14 09:00 [entrez]
AID - 10.1055/s-2006-944959 [doi]
PST - ppublish
SO  - Endoscopy. 2006 Dec;38(12):1284-8. doi: 10.1055/s-2006-944959.