title: Efficacy of simulated epinephrine-containing epidural test dose after intravenous atropine during isoflurane anesthesia in children.
abstract: OBJECTIVE
  A double-blind, randomized study was performed to investigate heart rate (HR) and blood pressure responses to 2 doses of intravenous (IV) epinephrine (0.5 and 0.75 microg/kg) in 61 children, ages 3 months to 12 years.
  
  
  METHODS
  Anesthesia was maintained with isoflurane (age-adjusted 1 minimal alveolar concentration [MAC]) in oxygen. All patients received IV atropine (10 microg/kg) and 5 minutes later were randomized to receive IV solutions (0.1 mL/kg) containing 1% lidocaine (n = 19, group I) with saline; lidocaine 1% with epinephrine 0.5 microg/kg (n = 21, group II); or lidocaine 1% with epinephrine 0.75 microg/kg (n = 21, group III). HR was recorded at 0, 15, 30, 45, 60, 90 seconds, and 2, 3, 4, and 5 minutes after test-dose injection. Systolic blood pressure (SBP), diastolic blood pressure, and end-tidal carbon dioxide were recorded at steady-state isoflurane anesthesia, after the injection of atropine, and at 45-second intervals after test-dose injections.
  
  
  RESULTS
  Median maximum increases in HR were similar in groups II and III at 19 and 22 beats per minute (beats/min), respectively. An HR increase of > or =10 beats/min was observed in 19 of 21 patients who received 0.5 microg/kg epinephrine and 21 of 21 patients receiving 0.75 microg/kg. None of the patients in group I developed HR increases > or =10 beats/min. SBP increased > or =15 mm Hg in 17 of 21 patients in group II and 19 of 21 in group III. No dysrhythmias or T-wave amplitude change was noted.
  
  
  CONCLUSIONS
  A simulated epidural test dose containing lidocaine 1 mg/kg with epinephrine 0.75 microg/kg, administered IV following atropine, may reliably increase HR to indicate unintentional injection into epidural vessels of children anesthetized with 1 MAC isoflurane.
authors.affiliation: Department of Anesthesia, Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA. Sethna@hub.tch.harvard.edu
authors.forename: N F
authors.initials: NF
authors.lastname: Sethna
authors.forename: L
authors.initials: L
authors.lastname: Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Retik
authors.forename: F X
authors.initials: FX
authors.lastname: McGowan
authors.lastname: Di Canzio J
authors.forename: D
authors.initials: D
authors.lastname: Zurakowski
mesh_terms: D000769:Anesthesia, Inhalation; D001285:Atropine / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004837:Epinephrine; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007530:Isoflurane / Q000494:pharmacology*; D008297:Male
chemical_list: D001285:Atropine; D007530:Isoflurane; D004837:Epinephrine