title: Aging reduces the reliability of epidural epinephrine test doses.
abstract: OBJECTIVE
  The authors recently determined that intravascular injection of an epinephrine test dose reliably produced an increase in heart rate > or = 20 beats/min in young individuals. However, aging is associated with a significant reduction in beta-adrenergic responsiveness. This study was designed to determine whether aging decreases the magnitude of heart rate (HR) increase after intravascular injection of epinephrine.
  
  
  METHODS
  Heart rate and systolic blood pressure were recorded during randomized and double-blind injections of 3 mL lidocaine plain or lidocaine with 10 or 15 micrograms epinephrine in 30 elective surgical patients between 21 and 81 years old.
  
  
  RESULTS
  Increasing age was associated with smaller increases in HR after intravascular injection of epinephrine. The reduction in HR increase was statistically significant after 10 micrograms (P = .006, r2 = .24), but not after 15 micrograms (P = .25, r2 = .05) of epinephrine. Heart rate increases were of greater magnitude for patients younger than 40 years old (P = .01 for 10 micrograms epinephrine, and P = .03 for 15 micrograms epinephrine). One patient (of 11) over 60 did not respond to the 15 micrograms test dose with tachycardia. Aging did not alter systolic blood pressure increases after 10 or 15 micrograms epinephrine (P = .27, r2 = .04 and P = .4, r2 = .03, respectively).
  
  
  CONCLUSIONS
  Aging is associated with a reduction in the magnitude of HR increase after intravenous injection of epinephrine. The results suggest that to detect an intravascular injection in healthy people, a test dose containing 10 micrograms epinephrine will suffice before the age of 40. However, even 15 micrograms epinephrine will not be totally reliable in older patients, owing to decreased beta-adrenergic responsiveness.
authors.affiliation: Service d'Anesthésiologie, Clinique de Genolier, Switzerland.
authors.forename: J P
authors.initials: JP
authors.lastname: Guinard
authors.forename: M F
authors.initials: MF
authors.lastname: Mulroy
authors.forename: R L
authors.initials: RL
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000767:Anesthesia, Epidural / Q000379:methods*; D000776:Anesthesiology / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004837:Epinephrine / Q000494:pharmacology*; D005069:Evaluation Studies as Topic; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results
chemical_list: D008012:Lidocaine; D004837:Epinephrine