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How to Induce Arrhythmias with Ephedrine?

  • Arash Moosavi-Shalheh
Chapter

Abstract

Ephedrine is an alpha-beta agonist widely used for nasal decongestion, nervous system stimulation, and spinal anesthesia during cesarean section. Ephedra was used more than 5000 years ago in China and India for treating fever, flu, cold, chills, nasal congestion, coughing, and wheezing. Pseudoephedrine is an isomer of ephedrine. Ephedrine is a sympathomimetic drug that acts both on α- and β -adrenergic receptors. It directly stimulates α1, β 1, and β 2 adrenergic receptors. Furthermore, it indirectly stimulates the release of noradrenaline from the storage sites. The most important effects are the increase in the heart rate, increase in systolic and diastolic blood pressure, peripheral vasoconstriction, and relaxation of smooth muscle cells of bronchi. By adrenergic stimulation, ephedrine shortens atrial and ventricular refractory periods, permitting the development of both automatic and reentrant arrhythmias.

References

  1. 1.
    Henry B. Pseudoephedrine dilemma. W V Med J. 2014;110:6.PubMedGoogle Scholar
  2. 2.
    Rodos C. Ephedra ban: no shortage of reasons. FDA Consum. 2004;38:6–7.Google Scholar
  3. 3.
    Maughan RJ. Contamination of dietary supplements and positive drug tests in sport. J Sports Sci. 2005;23:883–9.CrossRefGoogle Scholar
  4. 4.
    Furlanello F, Bentivegna S, Cappato R, De Ambroggi L. Arrhythmogenic effects of illicit drugs in athletes. Ital Heart J. 2003;4:829–37.PubMedGoogle Scholar
  5. 5.
    Gajraj NM, Wallace DH, Pace NA. Supraventricular tachycardia in a parturient under spinal anesthesia. Reg Anesth. 1993;18:261–3.PubMedGoogle Scholar
  6. 6.
    Thurn AL, Betz JM. Ephedra. In: Coates PM, Betz JM, Blackman MR, et al., editors. Encyclopedia of dietary supplements. 2nd ed. London, UK: Informa Healthcare; 2010. p. 250–6.Google Scholar
  7. 7.
    Gosselin RE, Smith RP, Hodge HC. Clinical toxicology of commercial products. 5th ed. Baltimore: Williams and Wilkins; 1984. p. II–370.Google Scholar
  8. 8.
    Stoelting RK. Sympathomimetics. In: Stoelting RK, editor. Pharmacology and physiology in anesthetic practice. 3rd ed. Philadelphia: Lippincot-Raven; 1999. p. 259–77.Google Scholar
  9. 9.
    Schier JG, Traub SJ, Hoffman RS, Nelson LS. Ephedrine-induced cardiac ischemia: exposure confirmed with a serum level. J Toxicol Clin Toxicol. 2003;41:849–53.CrossRefGoogle Scholar
  10. 10.
    Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2002;97:1582–90.CrossRefGoogle Scholar
  11. 11.
    Natarajan AK, Singh NR, Singh LP, Devi RS, Devi NA, Jack A. Comparison of intravenous bolus phenylephrine and intravenous ephedrine during crystalloid in ameliorating hypotension under spinal anesthesia for cesarean section. J Med Soc. 2015;29:155–9.CrossRefGoogle Scholar
  12. 12.
    Adamson PB, Suarez J, Ellis E, Kanaly T, Vanoli E. Ephedrine increases ventricular arrhythmias in conscious dogs after myocardial infarction. J Am Coll Cardiol. 2004;44:1675–8.CrossRefGoogle Scholar
  13. 13.
    Loughrey JP, Yao N, Datta S, Segal S, Pian-Smith M, Tsen LC. Hemodynamic effects of spinal anesthesia and simultaneous intravenous bolus of combined phenylephrine and ephedrine versus ephedrine for cesarean delivery. Int J Obstet Anesth. 2005;14:43–7.CrossRefGoogle Scholar
  14. 14.
    Chan WS, Irwin MG, Tong WN, Lam YH. Prevention of hypotension during spinal anaesthesia for cesarean section: ephedrine infusion versus fluid preload. Anaesthesia. 1997;52:908–13.CrossRefGoogle Scholar
  15. 15.
    King SW, Rosen MA. Prophylactic ephedrine and hypotension associated with spinal anesthesia for cesarean delivery. Int J Obstet Anesth. 1998;7:18–22.CrossRefGoogle Scholar
  16. 16.
    Lee A, Ngan Kee WD, Gin T. A dose-response meta- analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg. 2004;98:483–90.CrossRefGoogle Scholar
  17. 17.
    Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2000;90:1390–5.CrossRefGoogle Scholar
  18. 18.
    Datta S, Alper MH, Osthemer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology. 1982;56:68–70.CrossRefGoogle Scholar
  19. 19.
    Kol IO, Kaygusuz K, Gursoy S, Cetin A, Kahramanoglu Z, Ozkan F, et al. The effects of intravenous ephedrine during spinal anesthesia for cesarean delivery: a randomized controlled trial. J Korean Med Sci. 2009;24:883–8.CrossRefGoogle Scholar
  20. 20.
    Cassela M, Dello Russo A, Izzo G, Pieroni M, Andreini D, Russo E, et al. Ventricular arrhythmias induced by long-term use of ephedrine in two competitive athletes. Heart Vessels. 2015;30:280–3.CrossRefGoogle Scholar
  21. 21.
    Abraham J, Mudd JO, Kapur NK, Champion HC, Klein K, Wittstein IS. Stress cardiomyopathy after intravenous administration of cathecolamines and beta-receptor agonists. J Am Coll Cardiol. 2009;53:1320–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Arash Moosavi-Shalheh
    • 1
  1. 1.Bispmotalagatan 2 lgh 1301MotalaSweden

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