PHARMACOLOGY OF EPINEPHRINE 135 



used as an analeptic particularly in cases of drowning and in 

 asphyxia neonatorum. 112 



Epinephrine is an antagonist to most cardiac depressants 

 particularly to chloroform and chloral. It is therefore used 

 in cases of failing circulation during anesthesia. 



In bronchial asthma, epinephrine relaxes the dilated bron- 

 chioles and the relief obtained by an asthmatic is often strik- 

 ing. The usefulness of epinephrine in asthma dates from be- 

 fore our knowledge of the sympathetic bronchodilators and 

 before the experimental demonstration of the dilating action 

 of epinephrine on bronchiolar constrictors. It is administered 

 subcutaneously in doses of ^ to 1 cc. of a 1:1000 solution. 112 



One of the most important therapeutic applications of 

 epinephrine is due to its local effects in constricting blood ves- 

 sels. Local ischaemia induced by epinephrine permits blood- 

 less operations on the eye and on the nasal and oral mucosae. 

 Epinephrine is also useful for stopping epistaxis. In the use 

 of epinephrine surgically as a hemostatic, it is necessary to 

 remember that small vessels subsequently bleed when the 

 effect of the epinephrine has disappeared. 520 The ischaemia 

 due to epinephrine may also cause delayed healing and even 

 necrosis. Although advocated for internal hemorrhage, it 

 would seem to be contraindicated in this condition. 



The application of the drug to a congested mucous membrane 

 is followed by contraction of the swollen mucosa and constric- 

 tion of the dilated blood vessels. The congestion of hay fever 

 is temporarily relieved by such applications. 



In urticaria, angioneurotic edema, serum sickness, and the 

 nitroid crises following the injection of arsphenamine, epi- 

 nephrine injections often give spectacular relief when adminis- 

 tered subcutaneously in doses of ^ to 1 cc. of the standard 

 1 : 1000 solution. 112 



In cases of acute traumatic shock in which there is a dilata- 

 tion of the capillary bed with an increase in capillary permea- 

 bility, it is doubtful if the transient cardiac stimulation and 



