Treatment for Pediatric bronchospasm

Specialties CRNA

Published

I'm not sure if this in the literature or not (probably) and I haven't really studied it yet, but...

If you have a 10kg kid with bronchospasm, what would you treatment be. I'm imagining, that in the pediatric population (and perhaps adults as well) that Epinephrine is the drug of choice. A cardiac arrest dose is 10mcg/kg, so knowing that Epi has greater efficacy for B2 receptors at lower doses, what kind of dose would you administer to the kid in the above situation?

I'm thinking 10-20 mcg and titrate.

sorry about my response regarding nitric oxide... but in truth, you wouldn't use nitric oxide for bronchospasm.... but you would use Heliox...

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Heliox being less dense and therefore creating less resistance to flow.

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The past few articles I've read in regard to using NO to treat bronchspasm did not show NO to be effective in alleviating bronchoconstriction. In fact, NO usually had deleterious effects including increased bronchial blood flow, exudation and edema, as well as direct cytotoxic effect on airway epithelial cells all of which can contribute to advancing the bronchospasm in the opinion of the researcher.

Good point Brenna's Dad, Heliox = helium plus oxygen at various ratios - the more helium used in the mixture the less dense, and there fore more effective at delivering oxygen beyond areas of bronchoconstriction. I have not come across any info on the role of helium as a bronchodilator.

Likewise, I have not found any information on the receptor selecitvity of varying dosages of epinephrine. BUT, i'm still searching :D

Have a good day

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helium isn't a bronchodilator - but due to its lower density it can carry albuterol past spastic lung tissue for better spread and quicker alleviation of the symptoms

beta-selectivity at low-dose of epinephrine is nicely portrayed in this image - literature sources include goodman & gilman, stoelting, etc.. as well as pubmed...

http://www.mc.uky.edu/pharmacology/instruction/decor/ar/epiab.jpg

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Thanks for posting that link Tenesma. I followed it back and printed off the entire section of Adrenergic Pharmacology - very helpful

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law of fives ... would you mind posting the page you got to for adrenergic pharmacology. The webpage I'm going to is telling me it doesn't exist. Thanks!

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