title: The combination of epinephrine and isoproterenol as a simulated epidural test dose in isoflurane-anesthetized adults.
abstract: During isoflurane anesthesia, an epinephrine-containing test dose produces unreliable heart rate (HR) responses with a high incidence of hypertension, whereas an isoproterenol-containing test dose results in a high incidence of hypotension. We designed this study to determine whether different combination doses of epinephrine and isoproterenol produce reliable HR changes without overt fluctuations of systolic blood pressure (SBP). Seventy-five healthy patients were anesthetized with 1% end-tidal isoflurane after endotracheal intubation and randomized to one of five groups (n = 15 each) according to the combination dose given i.v.: epinephrine 15 microg, epinephrine 15 microg + isoproterenol 1.5 microg, epinephrine 7.5 microg + isoproterenol 3 microg, isoproterenol 3 microg, and saline. HR and SBP were measured at 20-s intervals for 4 min after injection. Based on the conventional HR criterion (positive if > or = 20 bpm increase), the epinephrine 15 microg + isoproterenol 1.5 microg, the epinephrine 7.5 microg + isoproterenol 3 microg, and the isoproterenol 3 microg groups yielded 100% sensitivities, specificities, and positive and negative predictive values, whereas all groups yielded 100% efficacy according to the modified HR criterion (positive if > or = 10 bpm increase). Four (27%) and three patients (20%) in the epinephrine 15 microg and the epinephrine 15 microg + isoproterenol 1.5 microg groups, respectively, developed systolic hypertension (SBP > or = 180 mm Hg), whereas four (27%) patients in the isoproterenol 3 microg group developed systolic hypotension (SBP < or = 80% of the preinjection value). We conclude that epinephrine 7.5 microg + isoproterenol 3 microg provides the most reliable HR changes with the least SBP fluctuations.
  
  
  CONCLUSIONS
  To test whether an epidural catheter may be in a blood vessel, various vasoactive drugs are administered during general anesthesia. The authors found that the combination of epinephrine 7.5 microg and isoproterenol 3 microg produced the most reliable heart rate changes with minimal blood pressure fluctuations.
authors.affiliation: Department of Anesthesia, Akita University, School of Medicine, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Nishikawa
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage*; D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D001808:Blood Vessels / Q000293:injuries; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007022:Hypotension / Q000139:chemically induced; D007268:Injections, Epidural / Q000009:adverse effects; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000008:administration & dosage*; D007545:Isoproterenol / Q000008:administration & dosage*; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000322:Adrenergic Agonists; D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D007530:Isoflurane; D007545:Isoproterenol; D004837:Epinephrine