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Anesth Analg 2005;101:584-588
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000157571.00717.08

REGIONAL ANESTHESIA

Digital Skin Blood Flow as an Indicator for Intravascular Injection of Epinephrine-Containing Simulated Epidural Test Dose in Sevoflurane-Anesthetized Adults

Hany A. Mowafi, MB, Bch, MSc, MD

Department of Anesthesia, Faculty of Medicine, King Faisal University, Saudi Arabia

Address correspondence and reprint requests to Dr. Hany A. Mowafi, Anesthesiology Department, King Fahd University Hospital, PO Box 40081, Al-Khobar 31952, Saudi Arabia. Address e-mail to hany_mowafi{at}hotmail.com.

I designed this study to determine the efficacy of heart rate (HR), systolic blood pressure (SBP), and digital skin blood flow (DSBF) in detecting intravascular injection after a simulated epidural test dose containing 15 µg of epinephrine in sevoflurane-anesthetized adults. In addition, the testing threshold using DSBF was derived. Eighty patients were randomized to receive either 0.5 minimum alveolar anesthetic concentration (MAC) sevoflurane or 1.0 MAC sevoflurane and nitrous oxide in oxygen (n = 40 for each sevoflurane concentration). Each group of patients was further randomized to receive either 3 mL of 1.5% lidocaine containing 15 µg of epinephrine IV or 3 mL of saline IV (n = 20 each). HR, SBP, and DSBF were monitored for 5 min after injection. By using the HR (positive if ≥10 bpm increase) and SBP (positive if ≥15 mm Hg increase) criteria, a positive response rate to epinephrine was 95% for both variables during 0.5 MAC and 90% during 1.0 MAC sevoflurane anesthesia. Injection of the test dose resulted in peak DSBF decrease by 87% ± 8% and 81% ± 12% at 52 ± 10 and 53 ± 13 s in the sevoflurane 0.5 and 1.0 MAC groups, respectively. Positive DSBF criterion, as determined from peak increases during saline administration, was a decrease in DSBF ≥15%. Using this value, the sensitivity, specificity, positive predictive value, and negative predictive value were 100% in both sevoflurane groups. In conclusion, DSBF was superior to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose.




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H. A. Mowafi
The Efficacy of Plethysmographic Pulse Wave Amplitude as an Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Anesthetized Adults
Anesth. Analg., November 1, 2005; 101(5): 1506 - 1511.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.