Use of endotracheal epinephrine for refractory unanticipated post-intubation bronchospasm

Epinephrine is a commonly used agent for a variety of indications and clinical scenarios within the emergency department. It is commonly administered during cardiopulmonary arrest and serves as an option when there is a loss/lack of access. A female patient presented with respiratory depression secondary to opioid overdose, requiring emergent intubation. Shortly after intubation, she developed severe bronchospasm unresponsive to standard therapies including inhaled beta-agonists, intravenous corticosteroids, intramuscular epinephrine and sedation. As a last-resort intervention, 0.5 mg of epinephrine 1:10 000 in 10 mL normal saline was administered via the endotracheal tube, resulting in immediate clinical improvement in oxygen saturation and airway pressures. The purpose of this report is to describe the utilisation of 0.5 mg of epinephrine 1:10 000 in 10 mL normal saline given endotracheally for unanticipated post-intubation bronchospasm. The findings of this case support the idea that the endotracheal administration may be beneficial in the intubated patient with severe bronchospasm that is refractory to more traditional treatments.