title: The efficacy of epinephrine test doses during spinal anesthesia in volunteers: implications for combined spinal-epidural anesthesia.
abstract: Epinephrine test doses may be administered during combined spinal-epidural anesthesia to determine intravascular placement of epidural catheters. This study was designed to determine systolic blood pressure (SBP) and heart rate (HR) responses to intravenous injection of epinephrine (15 microg) during spinal anesthesia. Twelve volunteers received three spinal anesthetics (lidocaine 100 mg, tetracaine 15 mg, and bupivacaine 15 mg) in a randomized, double blind, cross-over fashion. Epinephrine was administered prior to spinal anesthesia (control), 30 min after injection of spinal anesthesia, and at regression of sensory block to T-10. SBP was measured with a radial arterial catheter and HR with an electrocardiogram. Positive responses were defined as peak increase in SBP > or = 15 mm Hg or HR > or = 20 bpm after injection of epinephrine. Compared with control, peak SBP responses decreased by a mean of 12 mm Hg during spinal anesthesia with tetracaine and bupivacaine (P < 0.05). Peak HR responses decreased by 11 bpm during all three spinal anesthetics (P < 0.05). Incidences of detection of intravenous injection by positive SBP and HR responses ranged from 50% to 100% and were not significantly affected by spinal anesthesia. Spinal anesthesia reduces hemodynamic responses to intravenous epinephrine injection but is unlikely to reduce detection by positive SBP and HR criteria.
authors.affiliation: Department of Anesthesiology, Virginia Mason Medical Center, University of Washington, Seattle, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Liu
authors.forename: R A
authors.initials: RA
authors.lastname: Stevens
authors.forename: J
authors.initials: J
authors.lastname: Vasquez
authors.forename: T C
authors.initials: TC
authors.lastname: Kao
authors.forename: T
authors.initials: T
authors.lastname: Sheikh
authors.forename: M
authors.initials: M
authors.lastname: Aasen
authors.forename: K
authors.initials: K
authors.lastname: Frey
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004837:Epinephrine / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans
chemical_list: D004837:Epinephrine