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Anesth Analg 2009; 108:549-553
© 2009 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31818fc35b
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PATIENT SAFETY

The Efficacy of Perfusion Index as an Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Propofol-Anesthetized Adults

Hany A. Mowafi, MBBch, MSc, MD, Salah A. Ismail, MBBch, MSc, MD, Mohammed A. Shafi, MBBch, MSc, MD, and AbdulMohsin A. Al-Ghamdi, MBBch, 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: Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter. In this study, we evaluated the efficacy of PI for detecting intravascular injection of a simulated epidural test dose containing 15 µg of epinephrine in adults during propofol-based anesthesia and compared its reliability with the conventional heart rate (HR) (positive if ≥10 bpm) and systolic blood pressure (SBP) (positive if ≥15 mm Hg) criteria.

METHODS: Forty patients scheduled for elective general surgery under total IV anesthesia were randomized to receive either 3 mL of lidocaine 15 mg/mL with epinephrine 5 µg/mL or 3 mL of saline IV (n = 20 each). HR, SBP, and PI were monitored for 5 min after injection.

RESULTS: Injecting the test dose resulted in an average maximum PI decrease by 65% ± 13% at 39 ± 15 s. Moreover, maximal increases in HR and SBP were 19 ± 8 bpm at 49 ± 25 s and 17 ± 7 mm Hg at 102 ± 34 s after test dose injections, respectively. Using the PI criterion for intravascular injection (positive if PI decreases ≥10% from the preinjection value) the sensitivity, specificity, positive predictive, and negative predictive values were 100% (95% confidence interval [CI]; CI = 83%–100%). On the contrary, sensitivities of 95% (CI = 76%–99%) and 90% (CI = 70%–97%) were obtained based on HR and SBP criteria, respectively.

CONCLUSION: PI is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose in propofol-anesthetized adult patients.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2009 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2009 by the International Anesthesia Research Society.