Pulmonary, Critical Care and Sleep Division, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
Pulm Pharmacol Ther. 2020 Oct;64:101961. doi: 10.1016/j.pupt.2020.101961. Epub 2020 Oct 7.
Phenylephrine has been administered endobronchially for airway bleeding during bronchoscopy as an alternative to epinephrine. Topical phenylephrine, often used in nasal surgery as a vasoconstrictor agent has been linked to cardiovascular morbidity.
To evaluate the safety of bronchoscopic instillation of phenylephrine during bronchoscopy.
We retrospectively reviewed patients who received endobronchial phenylephrine in our endoscopy suite. We compared the changes in blood pressure and heart rate before and after endobronchial phenylephrine administration. The safety of endobronchial phenylephrine was assessed with regards to the changes in hemodynamics and acute cardiovascular event, and 30-day mortality. Acute cardiovascular complications included acute coronary syndrome, aortic dissection, tachyarrhythmias, pulmonary edema and stroke.
We identified 30 patients who received endobronchial phenylephrine 100mcg/ml with a mean total volume of 6.5 ± 10.6 ml. They were given mainly for balloon dilation and cryobiopsy procedure (96.7%). On excluding patients who received concurrent IV pressor, there was a statistically significant increase of mean arterial pressure (MAP) by 12 ± 21 mmHg, p = 0.01 within 30 min of endobronchial phenylephrine compared to procedure day MAP baseline. There was 27% of patients with more than 20% increase in their MAP but none of the patients had MAP more than 140 nor the occurrence of acute cardiovascular event. There was no significant change in the patients' heart rate following endobronchial phenylephrine.
In our review, endobronchial phenylephrine with dose comparable to IV administration can cause significant raise in MAP but their absolute levels did not go beyond 180/120 mmHg nor resulted in acute cardiovascular complications.
在支气管镜检查期间，为了控制气道出血，苯肾上腺素已被经支气管内给药，作为肾上腺素的替代药物。局部使用苯肾上腺素作为血管收缩剂，常用于鼻外科手术，已与心血管发病率相关。
评估支气管镜检查期间经支气管内给予苯肾上腺素的安全性。
我们回顾性地审查了在我们的内镜室接受经支气管内苯肾上腺素治疗的患者。我们比较了经支气管内苯肾上腺素给药前后的血压和心率变化。根据血流动力学和急性心血管事件以及 30 天死亡率的变化，评估了经支气管内苯肾上腺素的安全性。急性心血管并发症包括急性冠状动脉综合征、主动脉夹层、心动过速、肺水肿和中风。
我们确定了 30 名接受 100mcg/ml 经支气管内苯肾上腺素治疗的患者，平均总剂量为 6.5±10.6ml。他们主要用于球囊扩张和冷冻活检程序（96.7%）。排除接受静脉内升压药物的患者后，与支气管镜检查日的 MAP 基线相比，经支气管内苯肾上腺素给药后 30 分钟内平均动脉压（MAP）平均升高 12±21mmHg，p=0.01。有 27%的患者 MAP 升高超过 20%，但没有患者的 MAP 超过 140，也没有发生急性心血管事件。经支气管内苯肾上腺素后患者的心率没有明显变化。
在我们的回顾中，与静脉内给药剂量相当的经支气管内苯肾上腺素可引起 MAP 显著升高，但它们的绝对水平并未超过 180/120mmHg，也未导致急性心血管并发症。
