Skip to main content

Haemodynamic response to a small intravenous bolus injection of epinephrine in cardiac surgical patients

  • N. W. F. Linton (a1) and R. A. F. Linton (a1)


Background and objective: The aim was to study the rapid changes in cardiac output and systemic vascular resistance produced by intravenous epinephrine (5 μg) on a beat-by-beat basis.

Methods: Ten patients were studied during cardiac surgery. Radial or brachial arterial pressure was recorded continuously during intravenous administration of epinephrine (5 μg). Cardiac output and systemic vascular resistance were derived for each beat using arterial pulse contour analysis calibrated by lithium indicator dilution. In each patient a further dose of epinephrine (5 μg) was administered during cardiopulmonary bypass with the blood flow kept constant so that changes in arterial pressure corresponded to changes in systemic vascular resistance.

Results: When the patients were not on cardiopulmonary bypass, the epinephrine produced an initial increase in systemic vascular resistance to 129 ± 15% (mean ± SD) of control, followed by a more prolonged reduction to 57 ± 13% of control. Cardiac output showed a small initial reduction coincident with the increase in systemic vascular resistance, followed by an increase to 152 ± 24% of control. During cardiopulmonary bypass, the changes produced by epinephrine on systemic vascular resistance were qualitatively similar but smaller in amplitude, probably because of a greater volume of dilution in the bypass circuit.

Conclusions: Small bolus doses of epinephrine produce an initial increase in systemic vascular resistance followed by a much greater reduction that may cause hypotension.

Corresponding author
Correspondence to: Nick Linton, The Rayne Institute, St Thomas' Hospital, London, SE1 7EH, UK. E-mail:; Tel: +44 (0)20 7928 9292 ext. 1944; Fax: +44 (0)20 7922 8394
Hide All


Linton NWF, Linton RAF. Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. Br J Anaesth 2001; 86: 486496.
Dale HH, Richards AN. The depressor (vaso-dilator) action of adrenaline. J Physiol 1927; 63: 201210.
Baraka A, Haroun S, Baroody MA, et al. The hemodynamic effects of intravenous norepinephrine versus epinephrine and phenylephrine in patients with ischemic heart disease. Middle East J Anesthesiol 1991; 11: 5362.
Linton R, Band D, O'Brien T, et al. Lithium dilution cardiac output measurement: A comparison with thermodilution. Crit Care Med 1997; 25: 17961800.
Stratton JR, Pfeifer MA, Ritchie JL, et al. Hemodynamic effects of epinephrine: concentration–effect study in humans. J Appl Physiol 1985; 58: 1199206.
Hardman JG, Limbird LE, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th edn. New York, USA: McGraw-Hill, 1996.
Sato Y, Matsuzawa H, Eguchi S. Comparative study of effects of adrenaline, dobutamine and dopamine on systemic hemodynamics and renal blood flow in patients following open heart surgery. Jpn Circ J 1982; 46: 10591072.
Karamanoglu M, Gallagher DE, Avolio AP, et al. Functional origin of reflected pressure waves in a multibranched model of the human arterial system. Am J Physiol 1994; 267: H1681H1688.
Liu SS, Carpenter RL. Hemodynamic responses to intravascular injection of epinephrine-containing epidural test doses in adults during general anesthesia. Anesthesiology 1996; 84: 8187.
Narchi P, Mazoit JX, Cohen S, et al. Heart rate response to an i.v. test dose of adrenaline and lignocaine with and without atropine pretreatment. Br J Anaesth 1991; 66: 583586.
Takahashi S, Tanaka M, Toyooka H. Fentanyl pretreatment does not impair the reliability of an epinephrine-containing test dose during propofol–nitrous oxide anesthesia. Anesth Analg 1999; 89: 743747.
Mackie K, Lam A. Epinephrine-containing test dose during beta-blockade. J Clin Monit 1991; 7: 213216.
Belani K, Ozaki M, Hynson J, et al. A new noninvasive method to measure blood pressure: results of a multicenter trial. Anesthesiology 1999; 91: 686692.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

European Journal of Anaesthesiology
  • ISSN: 0265-0215
  • EISSN: 1365-2346
  • URL: /core/journals/european-journal-of-anaesthesiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Abstract views

Total abstract views: 41 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.