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PEDIATRIC ANESTHESIA

Cardiovascular Criteria for Epidural Test Dosing in Sevoflurane- and Halothane-Anesthetized Children

Sibylle A. Kozek-Langenecker, MD^*, Peter Marhofer, MD, Karin Jonas, MD, Tom Macik, MD, Georg Urak, MD, and Margot Semsroth, MD

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.

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