Epinephrine test dose in children: is it interpretable on ECG monitor?
BACKGROUND
Epidural and other regional blocks are performed in children under general anesthesia; the response to a 'test dose' may be altered during administration of general anesthetics. Limited data is available describing changes in electrocardiogram, blood pressure and heart rate (HR) following unintentional intravascular injection of a lidocaine-epinephrine-containing test dose, under sevoflurane anesthesia in children.


METHODS
Sixty-eight children undergoing elective surgeries under sevoflurane anesthesia were administered 0.1 ml x kg(-1) of 1% lidocaine with epinephrine 0.5 microg x kg(-1) or normal saline intravenously, to simulate an accidental intravascular test dose. T-wave changes in lead II on the anesthesia monitor and on a printed ECG were noted over the initial 1 min as well as changes in HR and systolic blood pressure (SBP) over an initial 3 min period.


RESULTS
Following injection of lidocaine-epinephrine, a significant increase in T-wave amplitude in lead II was noted in 91% of children on the ECG monitor and in 94% of children on the ECG printout of the same lead. In 64% of children, an increase in HR of > or =10 b x min(-1) and in 76% of children an increase in SBP of > or =15 mmHg was noted.


CONCLUSIONS
An increase in T-wave amplitude can easily be detected by carefully observing the ECG monitor or an ECG printout within a minute following the accidental i.v. administration of 0.1 ml x kg(-1) of 1% lidocaine-epinephrine (0.5 microg x kg(-1)) regional anesthetic test dose in children under sevoflurane anesthesia.
Varghese
Elsa
E
Department of Anesthesiology, Kasturba Medical College, Manipal, Karnataka, India.
Deepak
Kavaraganahalli Mukundarao
KM
Chowdary
Koneru Veera Raghava
KV
D000322:Adrenergic Agonists / Q000008:administration & dosage* / Q000494:pharmacology; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects* / Q000295:instrumentation; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D000077149:Sevoflurane; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D008012:Lidocaine; D004837:Epinephrine