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Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children
S A Kozek-Langenecker1, P Marhofer, K Jonas
1Departments of Anesthesiology and Intensive Care B, University of Vienna, School of Medicine, Vienna, Austria.
Insights
The T wave criterion reliably detects accidental intravascular injections in children during anesthesia. Sevoflurane anesthesia enhances detection compared to halothane, improving patient safety.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Accidental intravascular injection during anesthesia is a critical risk.
- Detecting such events promptly is vital for patient safety.
- Current detection methods rely on hemodynamic monitoring.
Purpose of the Study:
- To evaluate the detectability of a simulated intravascular test dose in children.
- To compare the efficacy of T wave changes versus hemodynamic parameters (heart rate, blood pressure) for detection.
- To assess the influence of sevoflurane and halothane anesthesia on test dose detectability.
Main Methods:
- Forty-two children (0.5-8 years) received simulated IV test doses (epinephrine or saline) during general anesthesia.
- Anesthesia was maintained with halothane or sevoflurane at 1.0 MAC in nitrous oxide.
- Detection criteria included T wave amplitude changes (≥25%), systolic blood pressure (SBP) increase (≥15 mm Hg), and heart rate (HR) increase (≥10 bpm).
Main Results:
- The T wave criterion showed 100% (sevoflurane) and 90% (halothane) detection rates.
- Hemodynamic criteria (SBP, HR) had lower detection rates, ranging from 71% to 95%.
- Sevoflurane attenuated T wave and SBP responses less than halothane.
Conclusions:
- The T wave criterion is more reliable than conventional hemodynamic criteria for detecting intravascular injections.
- Sevoflurane anesthesia may improve the recognition of accidental epinephrine injections compared to halothane.
- These findings enhance patient safety protocols in pediatric anesthesia.
Unlabelled:
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 microg/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.