Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children.
This study was designed to determine the detectability of a simulated IV test dose in children during administration of general anesthesia by using heart rate (HR), systolic blood pressure (SBP), and T wave criterion. Forty-two children (0.5-8 yr old) received an IV injection containing epinephrine 0.5 microg/kg and another IV injection containing saline during either halothane or sevoflurane anesthesia administration at 1.0 minimum alveolar concentration in nitrous oxide. A positive test response was defined as a change in T wave amplitude >/=25%, SBP increase >/=15 mm Hg, and HR increase >/=10 bpm. By using the T wave, SBP, and HR criteria, a positive response rate to epinephrine was 100%, 95%, and 71%, respectively, during sevoflurane, and 90%, 71%, and 71%, respectively, during halothane anesthesia administration. These data suggest that the T wave criterion is superior to conventional hemodynamic criteria, and that sevoflurane attenuates T wave and SBP responses less than halothane; however, chronotropic responses are similar to halothane.


CONCLUSIONS
We found a greater reliability of the T wave criterion over conventional hemodynamic criteria for detecting intravascular injection of a simulated epidural test dose. Sevoflurane may increase the likelihood of recognition of an accidental intravascular injection of epinephrine-containing solutions in clinical practice compared with halothane.
Kozek-Langenecker
S A
SA
Departments of Anesthesiology and Intensive Care B, University of Vienna, School of Medicine, Vienna, Austria.
Marhofer
P
P
Jonas
K
K
Macik
T
T
Urak
G
G
Semsroth
M
M
D000765:Anesthesia, Conduction / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography / Q000187:drug effects; D004837:Epinephrine / Q000494:pharmacology; D006221:Halothane / Q000008:administration & dosage*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008738:Methyl Ethers / Q000494:pharmacology*; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D006221:Halothane; D004837:Epinephrine