Update on epinephrine (adrenaline) for pediatric emergencies

Walker, David M.

doi:10.1097/mop.0b013e32832b1067

Cited by 16 publications

(17 citation statements)

References 45 publications

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“…3,4,17 Biphasic reactions generally occur within 8 hours of the first episode, but they may manifest up to 72 hours later. 9,17,18 Awareness of this issue is critical for management of anaphylaxis. Biphasic reactions emphasize the importance of the availability of a second EAI and may necessitate retreatment after discharge from an ED.…”

Section: Clinical Features Of Anaphylaxismentioning

confidence: 99%

Update in Pediatric Anaphylaxis

Chipps

2013

Clin Pediatr (Phila)

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Anaphylaxis is common in children and has many differences across age groups. A systematic review of the literature from the past 5 years was conducted with the goal of updating the pediatrician. Food is the most common trigger in children, but insect venom and drugs are other typical causes. Clinical diagnostic criteria include dermatological, respiratory, cardiovascular, and gastrointestinal manifestations. A biphasic reaction is seen in some, with recurrence usually within 8 hours of the initial episode. Epinephrine is the drug of choice for acute reactions and the only medication shown to be lifesaving when administered promptly, but it is underutilized. Patients should have ready access to ≥2 doses of an epinephrine autoinjector, with thorough training regarding correct use of a given device and an emergency action plan. Management of anaphylaxis in schools presents distinct challenges. Pediatricians are in a unique position to assess and treat these patients chronically.

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Section: Clinical Features Of Anaphylaxismentioning

confidence: 99%

Update in Pediatric Anaphylaxis

Chipps

2013

Clin Pediatr (Phila)

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“…Worryingly, there is significant anecdotal evidence and safety data to suggest that AAIs do not always perform adequately and can misfire 5–7. The design of currently available AAIs has not changed significantly in decades.…”

Section: Introductionmentioning

confidence: 99%

Are adrenaline autoinjectors fit for purpose? A pilot study of the mechanical and injection performance characteristics of a cartridge- versus a syringe-based autoinjector

Schwirtz

Seeger²

2010

JAA

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Background:Adrenaline autoinjectors (AAIs) are prescribed to facilitate the intramuscular administration of adrenaline in patients diagnosed with life-threatening anaphylaxis. This pilot study investigated the injection and functional properties of two AAIs (deploying different delivery systems) under standard conditions, after dynamic and mechanical stresses, and in the presence of denim.Methods:The differences between a cartridge-based AAI (EpiPen® Junior) and a syringe-based AAI (Anapen® Junior) were assessed using three sets of tests. Test 1: under standard conditions, the injection depth and dose were measured in ballistic gelatine (a validated tissue simulant). Test 2: before the safety cap removal and activation forces were measured, AAIs were subjected to either of two preconditioning tests: 1) free-fall drop test; or 2) static load (ie, 400 N, equivalent to 40 kg weight) test; or 3) no preconditioning. Test 3: under standard conditions, injection properties into ballistic gelatine in the presence and absence of denim were investigated. Statistical analyses were performed using the Student’s t-test or Welch’s test.Results:The maximum depth of delivery was significantly greater with cartridge AAI (n = 4, mean 21.09 ± 2.54 mm) than with syringe AAI (n = 5; mean 11.64 ± 0.80 mm; P = 0.003). After 2.5 seconds, cartridge AAI (n = 4) discharged significantly more dose than syringe AAI (n = 3; 74.3% versus 25.7% of total dose; P = 0.001). Both cartridge and syringe AAI withstood the free-fall drop test, but almost all devices failed to activate following the static load test. Under standard conditions, significantly less force was required to remove the safety cap of cartridge AAI than syringe AAI (both n = 15; mean 9.56 ± 2.36 N versus 20.23 ± 6.61 N, respectively; P < 0.001), but a significantly greater activation force was required for cartridge AAI than syringe AAI (mean 23.01 ± 3.96 N versus 8.06 ± 0.51 N, respectively; P < 0.001). The presence of denim did not alter the activation force or effective needle length of either of the AAIs.Conclusion:Cartridge AAI appears significantly more capable of consistently and rapidly delivering a clinically relevant dose of intramuscular adrenaline than syringe AAI. However, both devices showed shortcomings in their ability to sustain mechanical stress similar to that which is likely over their shelf life, and as such, may not be fit for life-saving purpose.

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“…In such circumstances, an alternative simply usable and reliable route of epinephrine administration is requested. Intramuscular epinephrine is the initial treatment of choice and well established for systemic anaphylaxis, but as to our knowledge, not yet investigated for treatment of circulatory arrest. Serum peak concentrations depend on the injection site and were found to be five times higher after i.m.…”

Section: Discussionmentioning

confidence: 99%