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REGIONAL ANESTHESIA

The Efficacy of Plethysmographic Pulse Wave Amplitude as an Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Anesthetized Adults

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

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

In this study, I evaluated the efficacy of plethysmographic pulse wave amplitude (PPWA) in detecting intravascular injection of a simulated epidural test dose containing 15 µg of epinephrine in adults during either sevoflurane or isoflurane inhaled anesthesia and compared its reliability to the classical heart rate (HR; positive if 10 bpm) and systolic blood pressure (SBP; positive if 15 mm Hg) criteria. Eighty patients were randomized to receive either 1 mean alveolar anesthetic concentration of sevoflurane or 1 mean alveolar anesthetic concentration of isoflurane (n = 40 for each anesthesia group). Patients in each anesthesia group were 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 PPWA were monitored for 5 min after injection. Injection of the test dose resulted in peak PPWA decrease by 61% ± 17% and 58% ± 15% at 61 ± 12 s and 63 ± 13 s in the sevoflurane and isoflurane groups, respectively. Positive PPWA criterion, as determined from peak increases during saline administration, was a decrease in PPWA 10%. Using this value, the sensitivity, specificity, positive predictive, and negative predictive values of PPWA were 100% in both anesthetic groups. On the contrary, sensitivities of 85% and 95% were obtained based on HR criterion in the sevoflurane and isoflurane patients, respectively, and a sensitivity of 90% was obtained in both anesthesia groups on the basis of SBP criterion. In conclusion, PPWA is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose.

This article has been cited by other articles:

				H. A. Mowafi, S. A. Ismail, M. A. Shafi, and A. A. Al-Ghamdi The Efficacy of Perfusion Index as an Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Propofol-Anesthetized Adults Anesth. Analg., February 1, 2009; 108(2): 549 - 553. [Abstract] [Full Text] [PDF]

				H. A. Mowafi, S. A. Arab, S. A. Ismail, A. A. Al-Ghamdi, and R. R. Al-Metwalli Plethysmographic Pulse Wave Amplitude Is an Effective Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Sevoflurane-Anesthetized Pediatric Patients Anesth. Analg., November 1, 2008; 107(5): 1536 - 1541. [Abstract] [Full Text] [PDF]

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