title: Electrocardiographic and haemodynamic alterations caused by three different test solutions of local anaesthetics to detect accidental intravascular injection in children.
abstract: BACKGROUND
  The aim of this study was to investigate ECG and haemodynamic alterations provoked by a test dose of bupivacaine, epinephrine, and their combination.
  
  
  METHODS
  Paediatric patients undergoing general anaesthesia were randomized into three groups. After anaesthesia induction and tracheal intubation, 0.2 ml kg(-1) (max. 3 ml) of the corresponding test solution was i.v. injected: bupivacaine 0.125% (Group B), bupivacaine 0.125% plus epinephrine 1:200 000 (Group BE), or epinephrine 1:200 000 (Group E). ECG was printed and analysed post hoc. Non-invasive arterial pressure (AP) was measured at 1 and 2 min after test dose injection. Increases in T-wave of ≥ 25%, in heart rate (HR) of ≥ 10 beats min(-1), and in systolic AP of ≥ 15 mm Hg above baseline value were considered a positive result.
  
  
  RESULTS
  A total of 105 children aged 0.2-16 (median 6.8) yr were enrolled. Test dose injection provoked T-wave elevation in 0%, 85%, and 89% of patients in Groups B, BE, and E, respectively. A positive increase in HR was found in 0%, 68%, and 76%. A positive increase in AP at 1 min was found in 0%, 88%, and 94% and at 2 min in 0%, 42%, and 59%. A decrease in HR of ≥ 10 beats min(-1) was observed in 6%, 76%, and 69%. Alterations in T-wave and HR were significantly influenced by age.
  
  
  CONCLUSIONS
  ECG and haemodynamic alterations after i.v. injection of a local anaesthetic test dose were significantly influenced by epinephrine. T-wave elevation, increase in AP, and changes in HR are highly reliable variables, particularly when age is taken into account.
authors.affiliation: Department of Anaesthesia, University Children' s Hospital, Steinwiesstrasse 75, Zurich, Switzerland. jacqueline.mauch@kispi.uzh.ch
authors.forename: J Y
authors.initials: JY
authors.lastname: Mauch
authors.forename: N
authors.initials: N
authors.lastname: Spielmann
authors.forename: S
authors.initials: S
authors.lastname: Hartnack
authors.forename: M
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004562:Electrocardiography / Q000187:drug effects*; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D016343:Monitoring, Intraoperative / Q000379:methods; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine