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Potency of therapeutic adrenaline in injections

Chang P

Med J Malaya, 1970 Jun;24(4):287-9.
PMID: 4248349
Matched MeSH terms: Epinephrine/administration & dosage*; Epinephrine/pharmacology; Epinephrine/standards; Epinephrine/therapeutic use
Fulltext Management of anaphylaxis due to COVID-19 vaccines in the elderly

Bousquet J, Agache I, Blain H, Jutel M, Ventura MT, Worm M, et al.

Allergy, 2021 10;76(10):2952-2964.
PMID: 33811358 DOI: 10.1111/all.14838

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.

Matched MeSH terms: Epinephrine
State-of-the-art review: The advantage and use of Wide Awake Local Anaesthesia No Tourniquet (WALANT) for nerve decompression surgery

Ahmad AA, Lalonde DH

Int Orthop, 2025 Apr;49(4):959-963.
PMID: 39951053 DOI: 10.1007/s00264-025-06432-4

PURPOSE: Wide Awake Local Anesthesia No Tourniquet (WALANT) has gained significant attention since its introduction in 2005. Over 343 publications since 2013 highlight its increasing use in nerve decompression surgeries. WALANT is known for its safety benefits, cost-effectivenes and improved patient experience compared to traditional sedation and tourniquet-based methods. This review examines the advantages of WALANT in nerve decompression surgery, emphasizing its growing adoption and benefits.
METHODS: A comprehensive review of the WALANT technique is provided, focusing on injection strategies, including buffered lidocaine with epinephrine, proper needle placement and generous volume of tumescent anesthesia. Specific injection protocols and surgical approaches are discussed for various nerve decompression procedures such as carpal tunnel, lacertus, cubital tunnel, radial tunnel and lateral intermuscular septum releases.
RESULTS: WALANT eliminates sedation-related risks such as nausea, aspiration pneumonia and thromboembolism, making it suitable for high-risk patients (ASA 4). It reduces healthcare costs by decreasing the need for post-anesthesia care units and operating in minor procedure rooms. The technique fosters greater surgeon-patient interaction, reduces hospital stays and avoids preoperative fasting and testing. WALANT has demonstrated positive outcomes across multiple nerve decompression procedures.
CONCLUSION: WALANT provides a transformative approach in nerve decompression surgery, offering enhanced safety, cost-effectiveness and improved patient-centered care. It significantly contributes to positive surgical outcomes, making it a valuable technique for both patients and healthcare providers.

Matched MeSH terms: Epinephrine/administration & dosage
Fulltext Efficacy of vitamin B12 treatment on the adrenal gland of propylthiouracil-induced hypothyroid rats

Ajeel MT, Saleh HS, Din AM, Alashkham F, Said RM

Open Vet J, 2025 Jun;15(6):2395-2407.
PMID: 40989642 DOI: 10.5455/OVJ.2025.v15.i6.12

BACKGROUND: Hypothyroidism is characterized by insufficient production of thyroid hormones, which are crucial for metabolism. It often causes adrenal gland disturbances.
AIM: To evaluate the effect of vitamin B12 supplementation on adrenal gland disturbance in propylthiouracil-induced hypothyroid rats.
METHODS: Forty female rats were divided into four groups. Group 1 received normal saline. Group 2 received only vitamin B12 supplementation. Group 3 received 50 mg/kg of propylthiouracil (PTU). Group 4 received PTU and 25 µg/kg of vitamin B12. At the end of the experiment and after the animals' dissection, serum levels of thyroid-stimulating hormone (TSH), cortisol, epinephrine, and vitamin B12 were analyzed. The adrenal gland and thyroid glands were examined histologically.
RESULTS: The results of the present study revealed a significant increase in TSH hormone (2.23 ± 0.44) and epinephrine hormone (371.74 ± 24.29) in the hypothyroid group compared with the control group, while there is a significant decrease in cortisol hormone (88 ± 17.97) and vitamin B12 (297.52 ± 12.51) in the hypothyroid group compared with the control group, where the level of hormones in the (hypothyroid rats +B12) group became close to the level of hormones in the control group as well as significantly decreased TSH and epinephrine levels and increased cortisol and vitamin B12 serum levels. Histopathology examination showed that vitamin B12 reversed the adrenal gland damage caused by hypothyroidism, restoring the normal tissue structure.
CONCLUSION: Vitamin B12 mitigates hypothyroidism-induced adrenal gland damage by restoring hormonal balance and tissue integrity.

Matched MeSH terms: Epinephrine/blood
Synthesis of porous 2D layered nickel oxide-reduced graphene oxide (NiO-rGO) hybrid composite for the efficient electrochemical detection of epinephrine in biological fluid

Ramu AG, Umar A, Ibrahim AA, Algadi H, Ibrahim YSA, Wang Y, et al.

Environ Res, 2021 09;200:111366.
PMID: 34029547 DOI: 10.1016/j.envres.2021.111366

In the present research work, 2D-Porous NiO decorated graphene nanocomposite was synthesized by hydrothermal method to monitored the concentration of epinephrine (EPI). The morphology (SEM and TEM) results confirmed 2D-Porous NiO nanoparticles firmly attached over graphene nanosheets. FTIR and XPS analysis confirmed the formation of nickel oxide formation and complete reduction of GO to rGO. The electrochemical activity of the proposed NiO-rGO/GCE modified electrode on epinephrine was analyzed by simple cyclic voltammetry technique. The proposed low cost NiO-rGO/GCE modified electrode showed excellent catalytic activity over GCE and rGO/GCE electrodes. Due to its high conductivity and charge transfer ability of the NiO-rGO/GCE modified electrode exhibited high sensitivity of EPI at optimized conditions. The anodic peak current of the EPI linearly increases with increasing the concertation of EPI. A wide linear range (50 μM-1000 μM) was achieved with high correlation coefficient (R2 = 0.9986) and the limit of detection (LOD) of NiO-rGO/GCE modified electrode was calculated to be 10 μM. NiO-rGO/GCE electrode showed good stability and repeatability towards the EPI oxidation. Mainly, the proposed NiO-rGO/GCE modified electrode showed good sensitivity of EPI in the human biological fluid with high recovery percentage. The low cost, NiO-rGO/GCE electrode could be the promising sensor electrode for the detection of Epinephrine in the real samples.

Matched MeSH terms: Epinephrine
Vitamin-B12 deficiency in the megaloblastic anaemias of Malaya

TASKER PW, MOLLIN DL, BERRIMAN H

Br J Haematol, 1958 Apr;4(2):167-76.
PMID: 13536254
Matched MeSH terms: Epinephrine/pharmacology*
Epinephrine-secreting pheochromocytoma in a normotensive woman with adrenal incidentaloma

Sukor N, Saidin R, Kamaruddin NA

South. Med. J., 2007 Jan;100(1):73-4.
PMID: 17269532

Pheochromocytomas are rare neuroendocrine tumors that produce, metabolize, and usually secrete catecholamines. Although hypertension is a common presenting feature of pheochromocytoma, the tumors occur (or are present) in only 0.1% of patients with hypertension. The variability of symptoms and rarity of occurrence render these tumors difficult to diagnose; many are discovered incidentally during radiological examination or at autopsy. A patient is presented with a pheochromocytoma that was discovered incidentally when she presented with abdominal pain and a normal blood pressure.

Matched MeSH terms: Epinephrine/blood; Epinephrine/secretion*; Epinephrine/urine
A case of aplastic anaemia due to malaria successfully treated with adrenalin

Haridas G

Malayan Medical Journal, 1928;3:167.

Matched MeSH terms: Epinephrine
Vitamin‐B12 Deficiency in the Megaloblastic Anaemias of Malaya

Tasker PWG, Mollin DL, Berriman H

Br J Haematol, 1958;4:167-176.
DOI: 10.1111/j.1365-2141.1958.tb03847.x
Matched MeSH terms: Epinephrine
Fulltext Noise exposure effect on testicular histology, morphology and on male steroidogenic hormone

Swami CG, Ramanathan J, Charan Jeganath C

Malays J Med Sci, 2007 Jul;14(2):28-35.
PMID: 23515367 MyJurnal

The noise stress, after it passes through the hearing apparatus, not only affects the auditory apparatus but also other body functions. The alterations in the levels of cortical hormone, adrenocorticosterone, nor-epinephrine hormone (which are primarily considered as stress hormones) on follicular stimulating hormone, testosterone, and lutinizing hormone were reported in relation with stress. Male albino rats weighing 200 to 250 grams were exposed to 100 dB of noise for one hour and three hours in acute group and daily one hour exposure for 60 day, and 90 day in chronic group. The serum testosterone levels were measured in these animals. There was significant reduction in serum testosterone levels and this was similar with earlier reports. The tissues were collected for light and confocal microscopic study. 100dB of traffic noise exposure of varying duration had definite permanent effect on testicular histology and morphology and on the male sex hormone. The adaptation mechanism was noticed at the hormonal level only but the structural changes noticed were definite and permanent. The agglutinated dead sperms revealed the possibility of infertily when chronically exposed to noise stress.

Matched MeSH terms: Epinephrine
Fulltext Anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) in rural Sarawak, Malaysian Borneo

Steve Utap M, Bin Mohd Jamal MS

Rural Remote Health, 2019 08;19(3):5163.
PMID: 31421666 DOI: 10.22605/RRH5163

Nycticebus spp, commonly known as the slow lorus, is a small nocturnal primate found mainly in Asia. The adult slow loris weighs between 265 g and 1150 g depending on the type of species. It has a characteristic round head with large, forward-facing eyes. Slow lorises are known for their poisonous bite and are the only venomous primates. To date, there have been two published cases of slow loris bite in humans. This case report illustrates a case of anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) to a young man at Mulu District, in a remote area of Sarawak, Malaysian Borneo. The patient developed dyspnoea, a feeling of suffocation, swollen lips and cramp-like sensations over both hands. He subsequently developed syncope and hypotension. The patient was clinically stable following intramuscular injection of adrenaline 0.5 mg stat dose.

Matched MeSH terms: Epinephrine/administration & dosage*; Epinephrine/therapeutic use*
The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Ng KT, Teoh WY

Prehosp Disaster Med, 2019 Oct;34(5):532-539.
PMID: 31455452 DOI: 10.1017/S1049023X19004758

INTRODUCTION: Epinephrine has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly one century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether epinephrine increases the return of spontaneous circulation in OHCA patients.
METHODS: A systematic review and meta-analysis were conducted using the following databases: MEDLINE, EMBASE, and CENTRAL, from their inception until October 2018. All the randomized controlled trials (RCTs) were included. Observational studies, case reports, case series, and non-systematic reviews were excluded.
RESULTS: Two trials including 8,548 patients were eligible for inclusion in the data synthesis. In patients who received epinephrine during OHCA, the incidence of return of spontaneous circulation was increased, with an odds ratio (95%CI) of 4.25 (3.79-4.75), P

Matched MeSH terms: Epinephrine/administration & dosage; Epinephrine/therapeutic use*
Fulltext Bleeding peptic ulcer: experience with endoscopic therapy

Harjit K, Kandasami P, Hanafiah H

Med J Malaysia, 2002 Jun;57(2):154-60.
PMID: 24326645

Bleeding is a serious complication of peptic ulcer and mortality rate has remained at approximately 10% or more. Traditionally surgeons selected patients who were at significant risk of continued or re-bleeding and advocated early surgery. However, patients with bleeding peptic ulcers are generally elderly with coexisting medical illness and surgery results in significant morbidity and mortality. In the last decade, endoscopic haemostatic therapy has been effective in arresting the bleeding with surgical option considered only after endoscopic treatment has failed. We report the outcome of 196 patients who were endoscopically diagnosed to have bleeding from peptic ulcers. One hundred and thirty patients were to have active bleeding or recent bleed from the ulcer. Endoscopic adrenaline injection therapy was used in 53 patients who had active bleeding ulcers and another 77 patients with endoscopic evidence of recent bleed. The injection therapy was successfully in 127 (97.7%) patients. The treatment failed in three patients and they underwent urgent surgery. Re-bleeding occurred in 26 (20.5%) patients and endoscopic adrenaline therapy was repeated in these cases. Haemostatic was achieved in 19 patients, however 7 patients continued to bleed and required surgery. There were 3 deaths, principally from advanced age and coexisting medical illness. Endoscopic therapy for bleeding peptic ulcers is simply to apply, safe and effective. In cases of re-bleeding after initial endoscopic hemostasis, re-treatment is a preferable alternative to surgery. The role of surgery is limited to bleeding that is refractory or inaccessible to endoscopic control.

Matched MeSH terms: Epinephrine
Fulltext "Two Stones on One Bird": A Case Report on Severe Biphasic Anaphylaxis Masquerading as Life-Threatening Acute Asthma

Payus AO, Ibrahim A, Mustafa N

Open Access Maced J Med Sci, 2018 Nov 25;6(11):2136-2138.
PMID: 30559876 DOI: 10.3889/oamjms.2018.317

BACKGROUND: Anaphylaxis often misdiagnosed and treated as acute asthma, especially when it has a predominant respiratory symptom, and there are no obvious precipitants or previous allergic history. This morbid outcome is preventable if the level of suspicion for anaphylaxis is high among healthcare provider when treating a patient who is not responding to the standard management of acute asthma. A proportion of anaphylactic patient shows a biphasic reaction which potentially fatal when it is under-anticipated and prematurely discharge without adequate observation period after the recovery of the initial episode.
CASE REPORT: Here, we present a case of a young man who has childhood asthma with the last attack more than 10 years ago presented with symptoms suggestive of acute exacerbation of bronchial asthma. As the symptoms failed to improve after standard asthma management, anaphylaxis was suspected, and he was given intramuscular adrenaline 0.5 mg which leads to symptom improvement. However, he developed another attack shortly after improvement while under observation.
CONCLUSION: The objective of this case report is to emphasise the importance of keeping anaphylaxis in mind whenever a patient has treatment-refractory asthma, and also the anticipation of biphasic reaction that warrants adequate observation period especially those who are likely to have developed it.

Matched MeSH terms: Epinephrine
Fulltext Inadvertent injection of adrenaline into subarachnoid space--a case report

Mustafa WNA, Mohandas K

Med J Malaysia, 1982 Jun;37(2):108-9.
PMID: 7132830

A local anaesthetic agent with adrenalin meant for infiltration block was inadvertently given into spinal canal without any serious sequelae. The consequences of adrenalin in the subarachnoid space are discussed. Measures to prevent such accidents are suggested.

Matched MeSH terms: Epinephrine/adverse effects*
Cellular and hormonal control in glycogen metabolism--recent advances

Thambyrajah V, Karunairatnam MC

Med J Malaya, 1972 Sep;27(1):33-9.
PMID: 4345646
Matched MeSH terms: Epinephrine/metabolism
Plating of Distal Radius Fracture Using the Wide-Awake Anesthesia Technique

Ahmad AA, Yi LM, Ahmad AR

J Hand Surg Am, 2018 Nov;43(11):1045.e1-1045.e5.
PMID: 29866390 DOI: 10.1016/j.jhsa.2018.03.033

Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures. Because distal radius fracture fixation is usually performed under general or regional anesthesia with the use of a tourniquet, this exposes patients, especially elderly people with extensive comorbidities, to adverse effects commonly associated with these forms of anesthesia. As such, many of these patients are unable to undergo surgery in a timely manner until they are deemed medically fit for surgery or anesthesia, and some may still be treated nonsurgically. Injecting local anesthetic of lidocaine and epinephrine into the surgical field and without using a tourniquet is known to be advantageous for various surgical procedures of the hand. However, this approach, also known as wide-awake local anesthesia no tourniquet (WALANT), has not been used in the fixation of fractures beyond the wrist. Using the WALANT approach as an alternative anesthetic for plating of distal radius fractures may enable patients who are normally denied surgery owing to their age or medical comorbidities to undergo plate fixation for the fractures. This article outlines the WALANT approach used for a single case of fixation of distal end radius fracture with a detailed description of the technique of administering local anesthesia.

Matched MeSH terms: Epinephrine/administration & dosage
Effects of ascorbic acid on impaired vascular reactivity in aortas isolated from age-matched hypertensive and diabetic rats

Ajay M, Mustafa MR

Vascul Pharmacol, 2006 Aug;45(2):127-33.
PMID: 16807125 DOI: 10.1016/j.vph.2006.05.001

Impaired vascular reactivity is a hallmark of several cardiovascular diseases that include hypertension and diabetes. This study compared the changes in vascular reactivity in age-matched experimental hypertension and diabetes, and, subsequently, tested whether these changes could be affected directly by ascorbic acid (10 microM). Endothelium-derived nitric oxide (NO) modulation of ascorbic acid effects was also investigated. All the experiments were performed in the presence of a cyclooxygenase inhibitor, indomethacin (10 microM). Results showed that the endothelium-dependent and -independent relaxations induced by acetylcholine (ACh) and sodium nitroprusside (SNP), respectively, were blunted to a similar extent in isolated aortic rings from age-matched spontaneously hypertensive (SHR) (R(max): ACh = 72.83+/-1.86%, SNP = 96.6+/-1.90%) and diabetic (Rmax: ACh = 64.09+/-5.14%, SNP = 95.84+/-1.41%) rats compared with aortic rings of normal rats (Rmax: ACh = 89%, SNP = 104.0+/-1.0%). The alpha1-receptor-mediated contractions induced by phenylephrine (PE) were augmented in diabetic (Cmax = 148.8+/-9.0%) rat aortic rings compared to both normal (Cmax = 127+/-6.9%) and SHR (Cmax = 118+/-4.5%) aortic rings. Ascorbic acid pretreatment was without any significant effects on the vascular responses to ACh, SNP and PE in aortic rings from normal rats. Ascorbic acid significantly improved ACh-induced relaxations in SHR (Rmax = 89.09+/-2.82%) aortic rings to a level similar to that observed in normal aortic rings, but this enhancement in ACh-induced relaxations was only partial in diabetic aortic rings. Ascorbic acid lacked any effects on SNP-induced relaxations in both SHR and diabetic aortic rings. Ascorbic acid markedly attenuated contractions induced by PE in aortic rings from both SHR (Cmax = 92.9+/-6.68%) and diabetic (Cmax = 116.9+/-9.4%) rats. Additionally, following inhibition of nitric oxide synthesis with l-NAME, ascorbic acid attenuated PE-induced contractions in all aortic ring types studied. These results suggest that (1) vascular hyper-responsiveness to alpha(1)-receptor agonists in diabetic arteries is independent of endothelial nitric oxide dysfunction; (2) ascorbic acid directly modulates contractile responses of hypertensive and diabetic rat aortas, likely through mechanisms in part independent of preservation of endothelium-derived nitric oxide.

Matched MeSH terms: Epinephrine/analogs & derivatives; Epinephrine/pharmacology
Fulltext Randomized Clinical Trial of Periarticular Drug Injectionused in combination Patient-Controlled Analgesia versusPatient-Controlled Analgesia Alone in Total KneeArthroplasty

Sabran, M.N., Talha, A.J.M., Omar, M., Ibrahim, M.Y., Shahril, Y.

Malays Orthop J, 2008;2(2):21-26.
MyJurnal

This is a prospective randomized clinical trial to compare use of a combination of periarticular drug injection with patientcontrolled analgesia (PCA) to PCA alone in post-total knee arthroplasty (TKA). Thirty patients who were admitted for unilateral total knee arthroplasty were selected randomly into an Injection group or a Standard group. The periarticular injection contained Ropivacaine, Ketorolac and Adrenaline, given intra-operatively. The mean amount of opioid used was 22.87 mmol/L in the Injection group as compared to 39.78 mmol/L in the Standard group (p = 0.026). The Injection group had lower pain score at rest and during exercise (p=0.021, p=0.041, respectively), as well as better return to function (p=0.026) and shorter hospital stay (6.1 days, Injection; 7.5 days, Standard, p=0.027). Overall, the group receiving periarticular drugs injection had less pain, less narcotic usage, earlier return to function, similar experience of adverse effects and shorter hospital stays.

Matched MeSH terms: Epinephrine
Fulltext Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Epinephrine and Corticosteroid Therapy for Acute Bronchiolitis in Infants

Kua KP, Lee SWH

Front Pharmacol, 2017;8:396.
PMID: 28690542 DOI: 10.3389/fphar.2017.00396

Objective: To evaluate the effectiveness of combined epinephrine and corticosteroid therapy for acute bronchiolitis in infants. Methods: Four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) were searched from their inception to February 28, 2017 for studies involving infants aged less than 24 months with bronchiolitis which assessed the use of epinephrine and corticosteroid combination therapy. The methodological quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias Tool. A random-effects meta-analysis was used to pool the effect estimates. The primary outcomes were hospital admission rate and length of hospital stay. Results: Of 1,489 citations identified, 5 randomized controlled trials involving 1,157 patients were included. All studies were of high quality and low risk of bias. Results of the meta-analysis showed no significant differences in the primary outcomes. Hospitalization rate was reduced by combinatorial therapy of epinephrine and corticosteroid in only one out of five studies, whereas pooled data indicated no benefit over epinephrine plus placebo. Clinical severity scores were significantly improved in all five RCTs when assessed individually, but no benefit was observed compared to epinephrine monotherapy when the data were pooled together. Pooled data showed that combination therapy was more effective at improving oxygen saturation level (mean difference: -0.70; 95% confidence interval: -1.17 to -0.22, p = 0.004). There was no difference in the risk of serious adverse events in infants treated with the combined epinephrine and corticosteroid therapy. Conclusions: Combination treatment of epinephrine and dexamethasone was ineffective in reducing hospital admission and length of stay among infants with bronchiolitis.

Matched MeSH terms: Epinephrine

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