• J Nutman, L J Brooks, K M Deakins, K K Baldesare, M K Witte, and M D Reed.
• Division of Pediatric Pulmonary Medicine, Rainbow Babies and Childrens Hospital, Cleveland, OH.
• Crit. Care Med. 1994 Oct 1;22(10):1591-4.

ObjectiveTo determine whether any advantage exists using racemic epinephrine instead of the more potent and less expensive levo(1)-epinephrine in the treatment of postextubation laryngeal edema.DesignProspective, double-blind, randomized study.SettingPediatric intensive care unit in a university teaching hospital.PatientsTwenty-eight patients with stridor during the immediate postextubation period.InterventionsAfter extubation, patients demonstrating clinically important stridor were randomized in a double-blind fashion to receive an aerosol containing either 2.25% racemic or 1% l-epinephrine.Measurements And Main ResultsHeart rate, respiratory rate, blood pressure, and stridor score were determined at 20, 40, and 60 mins and 4 and 8 hrs after the initial aerosol administration. Patients in both groups demonstrated significant (p < .01) reductions in stridor score after aerosol administration. No significant differences were observed between treatment groups in improvement in stridor score or the number of subsequent aerosols required. Respiratory rate decreased significantly 40 and 60 mins after l-epinephrine but not after racemic epinephrine. No significant change in heart rate or blood pressure occurred after aerosol administration in either group.ConclusionsThese data suggest that aerosolized l-epinephrine is as effective as aerosolized racemic epinephrine in the treatment of postextubation laryngeal edema without additional adverse side effects. When dosed appropriately, l-epinephrine is a less expensive and more widely available alternative to racemic epinephrine for the treatment of postextubation laryngeal edema.

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