Open AccessA Comparative Study of Hemodynamic and T-Wave Criteria for Detecting Intravascular Injection of the Test Dose (Epinephrine) in Sevoflurane-Anesthetized Adults
Author(s) -
Makoto Tanaka,
Toshiaki Nishikawa
Publication year - 1999
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1097/00000539-199907000-00006
Subject(s) - sevoflurane , medicine , anesthesia , epinephrine , saline , lidocaine , heart rate , hemodynamics , blood pressure
This study was designed to determine the efficacy of heart rate (HR), systolic blood pressure (SBP), and changes in T-wave morphology in detecting intravascular injection of 15 microg of epinephrine (test dose) in sevoflurane-anesthetized adults. In addition, the testing threshold using the T-wave amplitude was derived. Ninety-six healthy patients were randomized to receive end-tidal sevoflurane 0.5%, 1%, or 2% and nitrous oxide 67% in oxygen (n = 32 for each sevoflurane concentration). Each group of patients was further randomized to receive 3 mL of 1.5% lidocaine plus 15 microg of epinephrine IV or 3 mL of saline IV (n = 16 each). HR, SBP, and T-wave amplitude were continuously monitored for 5 min after the IV injection of the study drug. None receiving IV saline and 15,15, and 14 patients receiving the IV test dose developed HR increases > or =10 bpm during 0.5%, 1%, and 2% sevoflurane, respectively. No patient receiving saline and all patients receiving the test dose developed SBP increases > or =15 mm Hg. T-wave amplitude decreased by >0.1 mV and by >25% in all patients receiving the IV test dose, and its magnitude was similar regardless of the sevoflurane concentrations. When 0.1-mV and 25% decreases in T-wave amplitude were considered as testing thresholds, 100% sensitivities and specificities were obtained. We conclude that a peak SBP increase > or =15 mm Hg and a decrease in T-wave amplitude > or =0.1 mV and > or =25% are more reliable than a HR increase > or =10 bpm for detecting intravascular injection of epinephrine-containing test dose during sevoflurane anesthesia.