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May 1, 1998Anesthesia & Analgesia

Simulation of an Epidural Test Dose with Intravenous Epinephrine in Sevoflurane-Anesthetized Children

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Why the study?

Does an IV test dose of epinephrine reliably increase heart rate to detect intravascular injection in sevoflurane-anesthetized children?

Population

60 ASA physical status I infants and children undergoing elective minor surgeries under 1.0 minimum alveolar…

Comparison

Simulated IV test dose consisting of 1%… vs Saline, administered with or without prior…

Design

RCT, randomly assigned

Follow-up

90 seconds

Authors

MTMakoto TanakaKanazawa UniversityTNToshiaki NishikawaAkita University

Discussion

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Implication

Standard ≥20 bpm HR criterion misses intravascular injection in many sevoflurane-anesthetized children; challenges conventional test-dose reliability and supports modified thresholds.

Structured PICO

Does an IV test dose of epinephrine reliably increase heart rate to detect intravascular injection in sevoflurane-anesthetized children?

P
Population
60 ASA physical status I infants and children (mean age 4.1 +/- 2.5 yr) undergoing elective minor surgeries under 1.0 minimum alveolar anesthetic concentration of sevoflurane and 60% nitrous oxide in oxygen.
I
Intervention
Simulated IV test dose consisting of 1% lidocaine (0.1 mL/kg) with 1:200,000 epinephrine (0.5 µg/kg), administered with or without prior atropine 0.01 mg/kg.
C
Comparator
Saline, administered with or without prior atropine 0.01 mg/kg.
O
Outcome
Hemodynamic responses (heart rate and systolic blood pressure changes).surrogate

During sevoflurane anesthesia in children, an epidural test dose containing epinephrine is unreliable using the conventional HR criterion (≥20 bpm increase) but reliable using a modified criterion (≥10 bpm increase).

Cite This Study

Tanaka et al. (1998) studied this question.

synapsesocial.com/papers/6a899672f8670bac6e334c6dhttps://doi.org/10.1213/00000539-199805000-00007
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy of an Epidural Test Dose in Children Anesthetized with Halothane1990 · 121 citations
  2. 2Isoproterenol is an Effective Marker of Intravenous Injection in Laboring Women1989 · 49 citations
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  4. 4Respiratory Sinus Arrhythmia during Recovery from Isoflurane???Nitrous Oxide Anesthesia1985 · 85 citations
  5. 5Some maternal complications of epidural analgesia for labour1985 · 194 citations