title: [Effects of preloading epidural space with epinephrine (1:200 000) on the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section].
abstract: OBJECTIVE
  To evaluate the effects of preloading epidural space with epinephrine (1:200 000) on the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section.
  
  
  METHODS
  Between May 2011 and December 2011, upon obtaining institutional ethics approval and informed consent from the Human Ethics Committee of Nanjing Medical University, 100 laboring women with singleton cephalic presentation at term, ASA (American Society of Anesthesiologists) class I-II, undergoing caesarean section under continuous epidural analgesia were randomly divided into E and N groups according to a random digit table (n = 50 each). After an identification of epidural space, 5 ml of normal saline with epinephrine (1:200 000) was injected into epidural space in group E and 5 ml of normal saline in group N through an epidural needle. The syringe plunger was pressed firmly for 20 seconds to ensure a sufficient diffusion. For both groups, the levels of mean arterial pressure and heart rates were recorded prior to anesthesia (T1), 2 min after switching into a supine horizontal position after successful puncture (T2), the time of fetal delivery (T3) and when surgery was over (T4). The cases with bloody fluid in epidural puncture needle during puncture or epidural catheter during catheter placement, fresh blood in epidural catheter and bloody fluid in caudal end of epidural catheter during extubation were recorded.
  
  
  RESULTS
  All hemodynamic changes were within the normal ranges. There were no obvious inter-group differences (P > 0.05). No significant difference existed in the cases with bloody fluid in epidural needle during catheter insertion (10% vs 12%) or epidural catheter during catheter placement (4% vs 6%), fresh blood in epidural catheter (0% vs 0%) or bloody fluid in caudal end of epidural catheter during extubation (26% vs 30%) between the groups (P > 0.05).
  
  
  CONCLUSIONS
  Preloading epidural space with epinephrine (1:200 000) may not lower the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China. mzhcb@yahoo.com.cn
authors.forename: Chuan-bao
authors.initials: CB
authors.lastname: Han
authors.forename: Xiu-hong
authors.initials: XH
authors.lastname: Jiang
authors.forename: Li
authors.initials: L
authors.lastname: Yu
authors.forename: Cong
authors.initials: C
authors.lastname: Lin
authors.forename: Zheng-nian
authors.initials: ZN
authors.lastname: Ding
authors.forename: Yan-ning
authors.initials: YN
authors.lastname: Qian
mesh_terms: D000328:Adult; D002404:Catheterization / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D004824:Epidural Space / Q000098:blood supply; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology*; D005260:Female; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D057772:Vascular System Injuries / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D004837:Epinephrine