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Departments of
*Anesthesiology and Intensive Care B, and
Anesthesiology and General Intensive Care A, University of Vienna, School of Medicine, Vienna, Austria
Address for correspondence and reprints to Sibylle A. Kozek-Langenecker, MD, Department of Anesthesiology and General Intensive Care, University of Vienna, 18–20 Währinger Gürtel, 1090-Vienna, Austria.
This study was designed to determine the detectability of a simulated IV test dose in children during administration of general anesthesia by using heart rate (HR), systolic blood pressure (SBP), and T wave criterion. Forty-two children (0.5–8 yr old) received an IV injection containing epinephrine 0.5 µg/kg and another IV injection containing saline during either halothane or sevoflurane anesthesia administration at 1.0 minimum alveolar concentration in nitrous oxide. A positive test response was defined as a change in T wave amplitude 
25%, SBP increase 15 mm Hg, and HR increase 10 bpm. By using the T wave, SBP, and HR criteria, a positive response rate to epinephrine was 100%, 95%, and 71%, respectively, during sevoflurane, and 90%, 71%, and 71%, respectively, during halothane anesthesia administration. These data suggest that the T wave criterion is superior to conventional hemodynamic criteria, and that sevoflurane attenuates T wave and SBP responses less than halothane; however, chronotropic responses are similar to halothane.
Implications: We found a greater reliability of the T wave criterion over conventional hemodynamic criteria for detecting intravascular injection of a simulated epidural test dose. Sevoflurane may increase the likelihood of recognition of an accidental intravascular injection of epinephrine-containing solutions in clinical practice compared with halothane.
This article has been cited by other articles:
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  J. Guay The epidural test dose: a review. Anesth. Analg., March 1, 2006; 102(3): 921 - 929. [Abstract] [Full Text] [PDF]
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K. Ogasawara, M. Tanaka, and T. Nishikawa Choice of Electrocardiography Lead Does Not Affect the Usefulness of the T-Wave Criterion for Detecting Intravascular Injection of an Epinephrine Test Dose in Anesthetized Children Anesth. Analg., August 1, 2003; 97(2): 372 - 376. [Abstract] [Full Text] [PDF]
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J. C. Eisenach, T. L. Yaksh, P. Marhofer, and M. Semsroth Epidural Ketamine in Healthy Children--What's the Point? * Response Anesth. Analg., February 1, 2003; 96(2): 626 - 627. [Full Text] [PDF]
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H. Hager, P. Marhofer, C. Sitzwohl, L. Adler, S. Kettner, and M. Semsroth Caudal Clonidine Prolongs Analgesia from Caudal S(+)-Ketamine in Children Anesth. Analg., May 1, 2002; 94(5): 1169 - 1172. [Abstract] [Full Text] [PDF]
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S. Takahashi, M. Tanaka, and H. Toyooka The Efficacy of Hemodynamic and T-Wave Criteria for Detecting Intravascular Injection of Epinephrine Test Dose in Propofol-Anesthetized Adults Anesth. Analg., March 1, 2002; 94(3): 717 - 722. [Abstract] [Full Text] [PDF]
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J. D. Tobias Caudal Epidural Block: A Review of Test Dosing and Recognition of Systemic Injection in Children Anesth. Analg., November 1, 2001; 93(5): 1156 - 1161. [Full Text] [PDF]
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M. Tanaka, R. Nitta, and T. Nishikawa Increased T-Wave Amplitude After Accidental Intravascular Injection of Lidocaine Plus Bupivacaine Without Epinephrine in Sevoflurane-Anesthetized Child Anesth. Analg., April 1, 2001; 92(4): 915 - 917. [Full Text] [PDF]
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