title: Aging reduces the efficacy of the simulated epidural test dose in anesthetized adults.
abstract: Aging is associated with reduced beta-adrenergic responsiveness. However, the age-related effects on hemodynamic changes and effectiveness of a simulated epidural IV test dose have not been defined during general anesthesia. We studied 20 (140 total) consecutive patients (ASA physical status I) assigned in each of the following age groups after endotracheal intubation and during stable end-tidal sevoflurane 2% and 67% nitrous oxide anesthesia (in yr): 10s, 20s, 30s, 40s, 50s, 60s, and 70s. Each group first received normal saline 3 mL IV, followed 4 min later by 1.5% lidocaine 3 mL plus 15 microg epinephrine (1:200,000) IV for 5 s. Heart rate (HR) and systolic blood pressure (SBP) were continuously monitored for 4 min after saline administration and the test dose injections. None receiving IV saline and all patients receiving IV test dose in age groups 10s to 50s developed HR increases > or = 10 bpm, whereas 17 and 13 patients met this HR criterion in age groups 60s and 70s (85% and 65% sensitivities), respectively. There was a significant inverse correlation between the maximum HR increase and the age (P: < 0.001 by Spearman's rank correlation). However, none receiving saline and all patients receiving IV test dose in all age groups developed SBP increases of 15 mm Hg, resulting in 100% efficacy based on the SBP criterion. We conclude that during stable sevoflurane anesthesia administration (a) the efficacy based on the HR criterion for detecting accidental intravascular injection of the epidural test dose is age-dependent, (b) the HR criterion may be clinically applicable only in patients <60 yr of age, and (c) the SBP criterion is effective for all age groups studied.
  
  
  CONCLUSIONS
  To determine whether an epidurally administered local anesthetic has been unintentionally injected into a blood vessel, a small dose of epinephrine is often added to a local anesthetic. We found that an increase in systolic blood pressure > or = 15 mm Hg is a more useful indicator than an increase in heart rate > or = 10 bpm in the patients > or = 60 yr old during stable sevoflurane anesthesia administration.
authors.affiliation: Department of Anesthesia, Akita University School of Medicine, Japan. mtanaka@med.akita-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Nishikawa
mesh_terms: D000293:Adolescent; D000316:Adrenergic alpha-Agonists; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D000767:Anesthesia, Epidural; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001794:Blood Pressure / Q000187:drug effects; D004824:Epidural Space / Q000502:physiology*; D004837:Epinephrine; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D011237:Predictive Value of Tests; D000077149:Sevoflurane
chemical_list: D000316:Adrenergic alpha-Agonists; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D004837:Epinephrine