| The combination of epinephrine and isoproterenol as a simulated epidural test dose in isoflurane-anesthetized adults. | |
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MedLine Citation:
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PMID: 9620526 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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During isoflurane anesthesia, an epinephrine-containing test dose produces unreliable heart rate (HR) responses with a high incidence of hypertension, whereas an isoproterenol-containing test dose results in a high incidence of hypotension. We designed this study to determine whether different combination doses of epinephrine and isoproterenol produce reliable HR changes without overt fluctuations of systolic blood pressure (SBP). Seventy-five healthy patients were anesthetized with 1% end-tidal isoflurane after endotracheal intubation and randomized to one of five groups (n = 15 each) according to the combination dose given i.v.: epinephrine 15 microg, epinephrine 15 microg + isoproterenol 1.5 microg, epinephrine 7.5 microg + isoproterenol 3 microg, isoproterenol 3 microg, and saline. HR and SBP were measured at 20-s intervals for 4 min after injection. Based on the conventional HR criterion (positive if > or = 20 bpm increase), the epinephrine 15 microg + isoproterenol 1.5 microg, the epinephrine 7.5 microg + isoproterenol 3 microg, and the isoproterenol 3 microg groups yielded 100% sensitivities, specificities, and positive and negative predictive values, whereas all groups yielded 100% efficacy according to the modified HR criterion (positive if > or = 10 bpm increase). Four (27%) and three patients (20%) in the epinephrine 15 microg and the epinephrine 15 microg + isoproterenol 1.5 microg groups, respectively, developed systolic hypertension (SBP > or = 180 mm Hg), whereas four (27%) patients in the isoproterenol 3 microg group developed systolic hypotension (SBP < or = 80% of the preinjection value). We conclude that epinephrine 7.5 microg + isoproterenol 3 microg provides the most reliable HR changes with the least SBP fluctuations. Implications: To test whether an epidural catheter may be in a blood vessel, various vasoactive drugs are administered during general anesthesia. The authors found that the combination of epinephrine 7.5 microg and isoproterenol 3 microg produced the most reliable heart rate changes with minimal blood pressure fluctuations. |
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Authors:
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M Tanaka; T Nishikawa |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 86 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1998 Jun |
Date Detail:
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Created Date: 1998-06-19 Completed Date: 1998-06-19 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1312-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia, Akita University, School of Medicine, Japan. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic Agonists
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administration & dosage* Adult Anesthesia, Inhalation* Anesthetics, Inhalation / administration & dosage* Blood Pressure / drug effects Blood Vessels / injuries Cardiotonic Agents / administration & dosage* Epinephrine / administration & dosage* Female Heart Rate / drug effects Humans Hypertension / chemically induced Hypotension / chemically induced Injections, Epidural / adverse effects Intubation, Intratracheal Isoflurane / administration & dosage* Isoproterenol / administration & dosage* Male Predictive Value of Tests Reproducibility of Results Sensitivity and Specificity |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic Agonists; 0/Anesthetics, Inhalation; 0/Cardiotonic Agents; 26675-46-7/Isoflurane; 51-43-4/Epinephrine; 7683-59-2/Isoproterenol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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