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Anesth Analg 2008; 107:1536-1541
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181844d08
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PEDIATRIC ANESTHESIOLOGY

Plethysmographic Pulse Wave Amplitude Is an Effective Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Sevoflurane-Anesthetized Pediatric Patients

Hany A. Mowafi, MBBch, MSc, MD, Samer A. Arab, MBBch, MD, Salah A. Ismail, MBBch, MSc, MD, Abdulmohsin A. Al-Ghamdi, MBBch, MD, and Roshdi R. Al-Metwalli, MBBch, MSc, MD

From the Department of Anesthesiology, Faculty of Medicine, King Faisal University, Saudi Arabia.

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

Abstract

BACKGROUND: Plethysmographic pulse wave amplitude (PPWA) was effective in detecting intravascular injection of epidural test dose with 100% sensitivity and specificity in adults. We evaluated the efficacy of PPWA in detecting intravascular injection of a simulated epidural test dose during sevoflurane anesthesia in pediatric patients.

METHODS: Eighty infants and children were randomized to receive either 0.5 minimal alveolar concentration (MAC) or 1 MAC sevoflurane and nitrous oxide in oxygen. Patients in each anesthesia group were further randomized to receive either 0.1 mL/kg of 1% lidocaine with 1:200,000 epinephrine (0.5 µg/kg of epinephrine) IV to simulate the intravascular injection of epidural test dose or saline. Heart rate (HR), systolic blood pressure (SBP), and PPWA were monitored for 5 min after injection. A positive test response was defined as HR increase ≥10 bpm, SBP increase ≥15 mm Hg, and PPWA decrease ≥10%.

RESULTS: Injecting the test dose resulted in an average maximum PPWA decrease by 69% ± 18% and 58% ± 14% at 79 ± 22 and 80 ± 19 s in the 0.5 MAC and 1 MAC sevoflurane groups, respectively. The sensitivity, specificity, positive predictive, and negative predictive values for PPWA were 100% in both sevoflurane groups, whereas by using HR and SBP criteria, the sensitivity was 90% and 95% respectively during 0.5 MAC sevoflurane anesthesia and 85% for both during 1 MAC sevoflurane anesthesia.

CONCLUSION: PPWA is effective for detection of an intravascular injection of a simulated epidural epinephrine-containing test dose in pediatric patients.




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 Anesth. Analg.Home page
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]


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 © 2008 by the International Anesthesia Research Society.