Key result
Intravenous phenylephrine (5 μg/kg) in children under sevoflurane anesthesia decreased heart rate by 25% from baseline at 1 minute, with increased blood pressure in 54% of patients.
Why the study?
Does intravenous phenylephrine elicit a reliable hemodynamic response to simulate an intravascular epidural test dose in children under sevoflurane anesthesia?
RCT (n=22)
Randomized
Does intravenous phenylephrine elicit a reliable hemodynamic response to simulate an intravascular epidural test dose in children under sevoflurane anesthesia?
Phenylephrine at 5 μg/kg decreases heart rate but does not consistently elicit a positive test dose response in children under sevoflurane anesthesia, indicating further dose-finding studies are needed.
Answers are grounded in this paper and cite their sources.
Phenylephrine 5 μg/kg fails to elicit a consistent test-dose response under sevoflurane; challenges reliability and warrants pediatric dose-finding trials.
BACKGROUND: A test dose is used to detect intravascular injection during neuraxial block in pediatrics. Accidental intravascular epidural local anesthetic injection might be unrecognized in anesthetized children leading to potential life-threatening complications. In children, sevoflurane anesthesia blunts the hemodynamic response when intravascular cathecolamines are administered. No studies have explored the hemodynamics and the criteria for a positive test dose result following phenylephrine in sevoflurane anesthetized children. METHODS: Healthy children undergoing minor procedures were randomly assigned to receive intravenous placebo, or 5 μg∙kg(-1) phenylephrine (n = 11/group) during sevoflurane anesthesia. Hemodynamic response was assessed using electrocardiography, pulse oxymetry and non-invasive blood pressure monitoring for 5 min following drug administration in anesthetized patients. RESULTS: All patients receiving phenylephrine showed a decreased heart rate (HR) but not all of them met the positive criterion for test dose response. Overall, at 1 min, patients receiving phenylephrine showed a 25% decrease in HR from the baseline while an increase in blood pressure was noticed in 54% of patients receiving phenylephrine. DISCUSSION: Phenylephrine might be a future indicator of positive intravascular test dose. Further investigation is needed to find out the phenylephrine dose that elicits a reliable hemodynamic response and whether phenylephrine needs to be dose age-adjusted in order to appreciate relevant hemodynamic changes in children receiving neuraxial blocks undergoing general anesthesia.
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Pancaro et al. (2013) conducted an RCT in Healthy children undergoing minor procedures (n=22). Phenylephrine vs. Intravenous placebo was evaluated on Hemodynamic response (heart rate and blood pressure). Intravenous phenylephrine (5 μg/kg) in children under sevoflurane anesthesia decreased heart rate by 25% from baseline at 1 minute, with increased blood pressure in 54% of patients.
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