Nebulization with adrenaline reduces respiratory secretions and inhibits the inflammatory process in the airways. (Photo: Reproduction)
O case of the boy Beníciosix years old, who died after taking an incorrect dosage of adrenaline into the veinin Amazonas, moved the country and raised questions about the use of the substance in cases of laryngitis.
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Benício arrived at Hospital Santa Júlia, in Manaus (AM)com dry cough and suspected laryngitis. The doctor prescribed nasal wash, serum and syrupin addition to three doses of intravenous adrenaline 3ml every 30 minutes.
Soon after the first application, the boy suddenly got worse and was taken to the red room, with oxygenation at 75%. THE boy went to Intensive Care Unit (ICU)he got worse and needed to be intubated. Benício suffered cardiac arrest and died in the early hours of Sunday (23).
Why is adrenaline prescribed for laryngitis?
A adrenaline is indicated for cases of laryngitismainly in cases of laryngotraqueobronquitis (crupe), because works by reducing edema (swelling) of the respiratory tract mucosa e relieves airway obstruction.
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One prospective study carried out at the University Hospital of USP evaluated the use of inhaled L-adrenaline in children with post-extubation laryngitis, and found its effectiveness in improving symptoms without causing side effects such as changes in heart rate, blood pressure or oxygen saturation.
However, all studies point to the common use of adrenaline only in nebulizationand not intravenously as in the case of Benício. The use of nebulizers is common in children with moderate to severe symptoms, to alleviate respiratory distress and avoid more serious complications.
Another study at the Federal University of Rio Grande do Sul (UFRGS) says that nebulized adrenaline (usually 3 to 5 ml at 1:1000 dilution) for laryngitis or croup is considered safe in children, with minor and transient side effects such as mild tachycardia (up to 7-10 bpm increase in heart rate), pallor (in up to 47% of cases in one study), hyperactivity, vomiting or skin erythema.
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Os Serious risks are associated with administration via the wrong routes such as rapid intravenous or excessive intramuscular injection, which can cause ventricular arrhythmias, myocardial ischemia or severe hypertension. Furthermore the cardiac monitoring is recommended during use.
