Document Detail

Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia.
MedLine Citation:
PMID:  19933529     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The use of local anesthetic test doses is standard practice when performing regional anesthesia. When an intravascular test dose is administered during inhaled anesthesia, the heart rate does not increase in about 25% of children; altered T-wave amplitude is a better indicator. No studies have examined the criteria for a positive result during total i.v. anesthesia (TIVA) in children. METHODS: We studied the effect of a simulated positive test dose on heart rate, arterial blood pressure, and T-wave amplitude in 17 ASA physical status I or II children receiving TIVA with propofol and remifentanil. Bupivacaine 0.25% 0.1 mL/kg with epinephrine 1:200,000 was injected i.v., and vital signs and electrocardiogram were continuously monitored. Increases of heart rate and arterial blood pressure >10% and T-wave amplitude >25% of baseline were considered clinically significant changes. RESULTS: All subjects had increased systolic and diastolic blood pressure (30.3% +/- 11.7% and 49.3% +/- 16.7%), which peaked within 120 s. Heart rate increases >10% of baseline occurred in 73% of subjects. T-wave amplitude increased in 33.3%, was unchanged in 25%, and decreased in 41.7% of subjects. CONCLUSIONS: A positive test dose during TIVA is best detected by increased arterial blood pressure. Twenty-seven percent of intravascular injections were missed using heart rate criteria. T-wave amplitude is not a reliable indicator of intravascular injection during TIVA. This is in marked distinction to what is seen during inhaled anesthesia.
David M Polaner; Jeannie Zuk; Kristi Luong; Zhaoxing Pan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-21
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  110     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-21     Completed Date:  2010-01-12     Revised Date:  2010-08-31    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-5     Citation Subset:  AIM; IM    
Department of Anesthesia, The Children's Hospital, 13123 East 16th Ave., B090, Aurora, CO 80045, USA.
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MeSH Terms
Anesthesia, Inhalation*
Anesthesia, Intravenous / methods*
Anesthetics, Intravenous / administration & dosage*,  diagnostic use*
Anesthetics, Local / administration & dosage*,  adverse effects*
Blood Pressure / drug effects
Bupivacaine / administration & dosage*,  adverse effects*
Child, Preschool
Electrocardiography / drug effects
Epinephrine / pharmacology
Heart / drug effects
Piperidines / administration & dosage*,  diagnostic use*
Propofol / administration & dosage*,  diagnostic use*
Reproducibility of Results
Vasoconstrictor Agents / pharmacology
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Anesthetics, Local; 0/Piperidines; 0/Vasoconstrictor Agents; 132875-61-7/remifentanil; 2078-54-8/Propofol; 2180-92-9/Bupivacaine; 51-43-4/Epinephrine
Comment In:
Anesth Analg. 2010 Sep;111(3):820-1; author reply 821   [PMID:  20733165 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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