RACEMIC VERSUS L-EPINEPHRINE AEROSOL IN THE TREATMENT OF POSTEXTUBATION LARYNGEAL EDEMA - RESULTS FROM A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND-STUDY

Objective: To determine whether any advantage exists using racemic epi nephrine instead of the more potent and less expensive levo(l)-epineph rine in the treatment of postextubation laryngeal edema. Design: Prosp ective, double-blind, randomized study. Setting: Pediatric intensive c are unit in a university teaching hospital. Patients: Twenty-eight pat ients with strider during the immediate postextubation period. Interve ntions: After extubation, patients demonstrating clinically important strider were randomized in a double-blind fashion to receive an aeroso l containing either 2.25% racemic or 1% l-epinephrine. Measurements an d Main Results: Heart rate, respiratory rate, blood pressure, and stri der score were determined at 20, 40, and 60 mins and 4 and 8 hrs after the initial aerosol administration. Patients in both groups demonstra ted significant (p < .01) reductions in strider score after aerosol ad ministration. No significant differences were observed between treatme nt groups in improvement in strider 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 signifi cant change in heart rate or blood pressure occurred after aerosol adm inistration in either group. Conclusions: These data suggest that aero solized l-epinephrine is as effective as aerosolized racemic epinephri ne in the treatment of postextubation laryngeal edema without addition al adverse side effects. When dosed appropriately, l-epinephrine is a less expensive and more widely available alternative to racemic epinep hrine for the treatment of postextubation laryngeal edema.