| Abstract | Spinal and epidural anesthesia [cumulatively referred to as neuraxial anesthesia] carry a low associated risk of bradycardia that could progress to asystolic cardiac arrest. Neuraxial anesthesia may inadvertently exceed anticipated therapeutic dermatomes and anesthetize nerves related to maintaining cardiovascular stability; instability may progress to cardiovascular collapse. The aim of this integrative review is to examine available evidence of epinephrine administration in response to predictive signs and symptoms of cardiovascular compromise. Current ACLS guidelines provide an emergent and reactive dose of epinephrine in response to a cardiac arrest. Could a proactive and more conservative administration of epinephrine mitigate deteriorating cardiovascular complications? The focus of this review includes: 1) signs and symptoms of impending cardiac arrest for prevailing commonality, 2) the timing of epinephrine administration, and 3) the dose of epinephrine to determine if low doses of epinephrine are more favorable for improved patient outcome. Databases (MEDLINE, Embase, and Pubmed) were searched using search terms epinephrine, cardiac arrest, neuraxial anesthesia, ACLS, guidelines, high spinal anesthesia, and asystole. Twenty-five articles were reviewed. Vigilant monitoring for cardiovascular compromise is a crucial component of the treatment process prior to the development of adult cardiac arrest. Early identification of patients at risk for developing cardiovascular symptoms that may progress to cardiac arrest is vital to preventing and treating these patients. Early intervention with epinephrine, a potent sympathomimetic agent, mitigates cardiovascular shortcomings during neuraxial anesthesia. Administering a low dose of epinephrine early in the recognition of cardiovascular compromise has been shown to be most effective in returning spontaneous circulation. Delayed administration of epinephrine produces unfavorable patient outcomes. Identifying early signs and symptoms of cardiovascular compromise is a critical component to treating cardiac arrest during neuraxial anesthesia. Vigilant monitoring of heart rate, blood pressure, and sensory level of blockade are easily identifiable cues regarding cardiovascular function. Prompt recognition allows early intervention with epinephrine. Administering a conservative dose of exogenous epinephrine at the earliest opportunity provides sympathetic support that may prevent full cardiovascular collapse. |
