| Epidural test dose: isoproterenol is a reliable marker for intravascular injection in anesthetized adults. | |
| | |
MedLine Citation:
|
PMID: 8610867 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Epidural test doses containing more than 15 micrograms epinephrine are reliable for the detection of intravascular injection based on the conventional systolic blood pressure (SBP) criterion (positive if > or = 15 mm Hg increase) but not on the heart rate (HR) criterion (positive if > or = 20 bpm increase) in adult patients anesthetized with isoflurane. The present study was designed to test whether isoproterenol could be used as a reliable marker. Thirty adult patients were randomly assigned to one of two groups, each of which was anesthetized with 1% end-tidal isoflurane and nitrous oxide after endotracheal intubation. Isoproterenol group (n = 15) was given 3 mL of 1.5% lidocaine with 3 micrograms isoproterenol intravenously (i.v.) to simulate an i.v. administered test dose. The saline group (n = 15) was identical to the isoproterenol group but received 3 mL of normal saline. HR and arterial blood pressure were measured at 20-s intervals for 4 min after i.v. injection. Mean HR in the isoproterenol group was significantly higher than in the saline group from 40 to 240 s after i.v. test dose with a mean maximum HR increase of 32 +/- 7 bpm (mean +/- SD) occurring at 68 +/- 19 s. All 15 patients in the isoproterenol group developed HR increases > or = 20 bpm (sensitivity 100%). Since HR was essentially unchanged in the saline group, specificity and positive and negative predictive values were all 100%. On the other hand, 12 of 15 patients in the isoproterenol group and none in the saline group exhibited SBP increases > or = 15 mm Hg, resulting in 80% sensitivity and 83% negative predictive value. In the isoproterenol group, however, transient systolic hypotension ( < 80% of the preinjection value) occurred in five patients without untoward clinical sequelae. These results indicate that, based on the peak HR response, the epidural test dose containing 3 micrograms isoproterenol is a reliable marker for intravascular injection in adult patients during isoflurane anesthesia. |
| | |
Authors:
|
M Tanaka |
Related Documents
:
|
15073707 - Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. 11334197 - Is compartment pressure related to plasma colloid osmotic pressure, in patients during ... 11744907 - Vasopressin as an etiologic factor for infection in gynecologic surgery: a randomized d... 8672317 - Effect of digital pressure on the neurovascular sheath during perivascular axillary block. 18314557 - Age-related changes of arterial mechanical properties in rats: analysis using exponenti... 15194177 - Diagnosis and differential assessment of pulmonary arterial hypertension. |
Publication Detail:
|
Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
|
Title: Anesthesia and analgesia Volume: 82 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1996 May |
Date Detail:
|
Created Date: 1996-05-24 Completed Date: 1996-05-24 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1056-9 Citation Subset: AIM; IM |
Affiliation:
|
Department of Anesthesia/Critical Care Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Anesthesia, Epidural* / adverse effects Anesthetics, Inhalation / administration & dosage Biological Markers Blood Pressure / drug effects Female Heart Rate / drug effects Humans Hypotension / chemically induced Injections, Epidural / adverse effects Injections, Intravenous Isoflurane / administration & dosage Isoproterenol / administration & dosage, adverse effects, diagnostic use* Lidocaine / administration & dosage Male Nitrous Oxide / administration & dosage Predictive Value of Tests Prospective Studies Reproducibility of Results Sensitivity and Specificity |
| Chemical | |
Reg. No./Substance:
|
0/Anesthetics, Inhalation; 0/Biological Markers; 10024-97-2/Nitrous Oxide; 137-58-6/Lidocaine; 26675-46-7/Isoflurane; 7683-59-2/Isoproterenol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The effect of thoracic epidural anesthesia on hypoxic pulmonary vasoconstriction in dogs: an analysi...
Next Document: The role of hyaluronidase on lidocaine and bupivacaine pharmacokinetics after peribulbar blockade.