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PEDIATRIC ANESTHESIA

The Age-Related Effects of Epidural Lidocaine, With and Without Epinephrine, on Spinal Cord Blood Flow in Anesthetized Rabbits

Hervé Bouaziz, MD^*,, Naomitsu Okubo, MD, Jean-Marc Malinovsky, MD, Dan Benhamou, MD^§, Kamran Samii, MD, and Jean Xavier Mazoit, MD, PhD

*Département d'Anesthésie, Hôpital Central, Nancy; Laboratoire d'Anesthésie, Université Paris-Sud, Faculté de Médecine du Kremlin-Bicêtre, Le Kremlin-Bicêtre; Département d'Anesthésie, Hôtel Dieu, Nantes; and §Département d'Anesthésie, Hôpital Antoine Béclère, Clamart, France

Address correspondence and reprint requests to Hervé Bouaziz, MD, Département d'Anesthésie, Hôpital Central, F-54035 Nancy Cedex, France.

The effect of epidural or spinal epinephrine when added to local anesthetics on spinal cord blood flow (SCBF)are controversial. We evaluated the effects of epidural lidocaine, with or without epinephrine, on spinal cord blood flow in young and adult rabbits receiving 2% plain lidocaine, 2% lidocaine with epinephrine (1:200,000), or saline epidurally. Colored microspheres were injected through the left ventricle 10 min before and 7.5 and 30 min after epidural injection. The organs (brain, heart, kidneys, and the L6-7 segment of the spinal cord) were analyzed for regional blood flow determination. A significant decrease in mean arterial pressure was observed after the administration of lidocaine, with or without epinephrine, in both adult and young animals compared with saline. SCBF did not change over time in adult rabbits. Conversely, a significant decrease in SCBF was observed in the two groups of young rabbits receiving lidocaine. This decrease correlated with the decrease in mean arterial pressure but did not correlate with the use of epinephrine. We conclude that any reduction in blood pressure occurring in pediatric patients receiving a combined epidural-general anesthetic may result in decreased SCBF.

Implications: In young rabbits, any decrease in blood pressure was followed by a decrease in spinal cord blood flow, a decrease that did not correlate to the use of epinephrine and was not observed in adult animals. These data suggest that blood pressure should be monitored closely to promptly treat any decrease in blood pressure when combined epidural-general anesthesia is used in children.