Racemic Epi vs Albuterol, Which is better?`

[TexasCCRN]

Why would you choose RE over albuterol? Would it be to stimulate B1 as well. I know albuterol will do this too, but I was just wondering if there are any other clinical applications that I am overlooking. Seems like albuterol would be the better choice for a pt with heart problems. Thanks

[MissJoRN, RN]

I realized this was the CRNA forum after I started to post... but will leave my pathetic little anwser here, anyway, from my pedi experience. I'm starting to care for more and sicker resp kids so looking forward to the feedback.

We use racemic epi for upper airway pathology- epiglottits, severe croup, flare up of underlying LTM, etc. (Usually with decadron as the choice steroid- I know docs who insist they be given at the same time, not sure exactly why but it does seem to work... when you can co-ordinate your meds with the RRT) It can be extremely effective for lower airway pathology but we try albuterol or Xopenex first and usually have the results we want for asthma- status or yellow/red zone maintainance, bronchiolitis, etc (with solu-medrol or pediapred as the steroid of choice) I do think HR is the main reason we avoid epi (and I avoid epi. We will use Xopenex instead of albuterol for those hearts that are too reactive to albuterol and hopefully do not need the epi!

[rt2crna]

Albuterol is one of the safest drugs you will find with as much effectiveness as it has. Also in the top ten of most commonly prescribed. Best choice for bronchospasm. RE is a little riskier and, as previously stated, is best for upper airway pathology. In the post-op arena, it is the drug of choice for post extubation stridor. The diagnosis of stridor can be tricky because the noise of the upper airway will be transmitted to the lungs, making you think wheeze based in the lung, when it's actually coming from the upper airway. Pearl: always listen to the throat before throwing albuterol at the problem. Albuterol will do almost nothing for the stridor, while RE will help stridor and bronchospasm. So if you're wrong about the source of the problem, you won't have wasted precious minutes with an ineffective albuterol neb trying to treat upper airway problems. Of course, you must weigh your options if the patient is tachycardic, as RE will almost always raise the pulse 20 bpm. On the other hand, is the pretreatment tachycardia due to hypoxia or respiratory distress? Then RE is your answer. Tough call, though.

[versatile_kat]

rt2crna said:

Albuterol is one of the safest drugs you will find with as much effectiveness as it has. Also in the top ten of most commonly prescribed. Best choice for bronchospasm. RE is a little riskier and, as previously stated, is best for upper airway pathology. In the post-op arena, it is the drug of choice for post extubation stridor. The diagnosis of stridor can be tricky because the noise of the upper airway will be transmitted to the lungs, making you think wheeze based in the lung, when it's actually coming from the upper airway. Pearl: always listen to the throat before throwing albuterol at the problem. Albuterol will do almost nothing for the stridor, while RE will help stridor and bronchospasm. So if you're wrong about the source of the problem, you won't have wasted precious minutes with an ineffective albuterol neb trying to treat upper airway problems. Of course, you must weigh your options if the patient is tachycardic, as RE will almost always raise the pulse 20 bpm. On the other hand, is the pretreatment tachycardia due to hypoxia or respiratory distress? Then RE is your answer. Tough call, though.

Nice post RT.

There was a similar question on studentdoctor and a pharmacist gave the answer of shelf like --- albuterol can last a long time in the package while RE has to be kept in the firdge and replaced quite frequently ($$$) ... hence the reason we use albuterol most of the time (for lower airway difficulties).

[rt2crna]

Right. RE has to be kept cold, but at our institution the anesthetist workroom is right off the R.R. where all the NMBs, etc. are stored in the fridge along with the racemic epi. Quite convenient.

[davvid2700]

Racemic epi has alpha vasoconstriction which is good for mucosal edema.. where as albuterol does not have alpha effects.. mostly b2

[TexasCCRN]

Thanks everyone for the info. I am sure we will get to this shortly at school. I just had to ask the question while it was in my very tightly squeezed brain! Thanks again!