Key result
Intravenous epinephrine induced a significantly higher acceleratory phase of tachycardia compared to contraction-associated tachycardia in laboring women (1.85 vs 0.69 bpm; P<0.0003).
Why the study?
Does the acceleratory phase of maternal heart rate discriminate between epinephrine-induced tachycardia and contraction-associated tachycardia in laboring women?
RCT (n=15)
Double-blind
random fashion
Does the acceleratory phase of maternal heart rate discriminate between epinephrine-induced tachycardia and contraction-associated tachycardia in laboring women?
Absolute Event Rate: 1.85% vs 0.69%
p-value: p=< 0.0003
On-line analysis of the acceleratory phase of maternal heart rate can accurately discriminate between epinephrine-induced and contraction-associated tachycardia during epidural analgesia.
Acceleratory phase monitoring may enable reliable detection of intravascular injection during labor epidural testing; confirms discrimination in randomized crossover design.
Maternal tachycardic responses to the intravenous injection of epinephrine 15 micrograms were compared with tachycardic responses induced by the pain of labor in a double-blind, prospective study of 15 women in active labor. After placement of an epidural catheter, maternal heart rate was continuously recorded. Each patient received, in uterine diastole, two injections of a test dose (epinephrine 15 micrograms + lidocaine 45 mg) at 2-4 min intervals, once via the epidural catheter and once intravenously in a random fashion. From the maternal heart rate strips, the acceleratory phase (bpm) of epinephrine-induced tachycardic responses (EITRs) and contraction-associated tachycardic responses (CATRs) were calculated. The upper bound of the 99% confidence interval (CI) to discriminate between the two groups was estimated. The acceleratory phase of EITRs was 1.85 +/- 0.61 bpm. The acceleratory phase of CATRs was 0.69 +/- 0.49 (P < 0.0003). The upper bound of the 99% CI was 1.17 bpm. Using this value to discriminate between EITRs and CATRs, all EITRs would be correctly identified. We conclude that on-line analysis of maternal tachycardic responses might be used in laboring women to discriminate between EITRs and CATRs and further improve the accuracy of an epinephrine test dose during the performance of epidural analgesia.
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Colonna-Romano et al. (1996) conducted an RCT in active labor (n=15). Intravenous epinephrine vs. Contraction-associated tachycardic responses was evaluated on Acceleratory phase of tachycardic responses (bpm) (p=< 0.0003). Intravenous epinephrine induced a significantly higher acceleratory phase of tachycardia compared to contraction-associated tachycardia in laboring women (1.85 vs 0.69 bpm; P<0.0003).
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