title: Toe skin temperature as a guide to epidural anaesthesia dosing.
abstract: To determine the time for additional epidural anaesthesia, skin temperature of the big toe was evaluated in 50 patients undergoing mastectomy. Epidural catheters were placed at or near the T5-6 intervertebral space and 12 ml, lidocaine 1.5% with 1:200,000 epinephrine were injected. When the skin temperature, which had increased following epidural anaesthesia, decreased by 0.3 degrees C without an increase of systolic arterial blood pressure (ABP) of more than 20%, 8 ml lidocaine 1.5% were injected. If the skin temperature increased, the monitor was judged to have been useful. When ABP increased > 20% without a decrease of skin temperature, the monitor was judged not to have been useful. Monitoring of toe skin temperature was useful in 39 patients (78%) in estimating the time for the first additional dose of epidural anaesthetic. First, second and third intervals between injection were 96.5 +/- 21.0 (n = 39), 69.7 +/- 14.2 (n = 35) and 50.1 +/- 12.2 min (n = 7), respectively. We conclude that, when epidural puncture is performed at upper thoracic levels, toe skin temperature can be a useful monitor to judge the time for additional anaesthetic.
authors.affiliation: Department of Anesthesiology, University of Tsukuba, Ibaraki, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Akiyoshi
authors.forename: H
authors.initials: H
authors.lastname: Ashimura
authors.forename: Y
authors.initials: Y
authors.lastname: Nishijima
authors.forename: N
authors.initials: N
authors.lastname: Okubo
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008408:Mastectomy; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012881:Skin Temperature / Q000502:physiology*; D013821:Thermometers; D014034:Toes
chemical_list: D008012:Lidocaine