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Effects of Epidural Test Dose Volume on Skin Perfusion, Temperature, and Reflex Vasoconstriction
  1. Marc A. Valley, M.D.*,
  2. Anne M. McKenzie, M.D.,
  3. Denis L. Bourke, M.D. and
  4. Srinivasa N. Raja, M.D.§
  1. *From the United States Air Force Medical Corps, Wilford Hall USAF Medical Center, and Department of Anesthesiology, University of Texas Health Science Center, San Antonio, Texas
  2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
  3. Division of Anesthesiology, Veteran's Administration Medical Center, Baltimore, Maryland, and
  4. §Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
  1. Reprint requests: Marc A. Valley, M.D., Major, USAF MC, Department of Anesthesiology/SGHSA, Wilford Hall Medical Center, Lackland AFB, TX 78236.


Background and Objectives. The authors sought to define the effects of differing volumes of epidural test dose on skin perfusion, skin temperature, and reflex vasoconstriction to a maximal inspiration (inspiratory gasp vasoconstrictive response, IGVR).

Methods. With informed consent and Institutional Review Board approval, the authors studied 40 patients undergoing epidural anesthesia. Skin perfusion was monitored in glabrous skin on the foot using laser Doppler. Inspiratory gasp vasoconstrictive response and temperature measurements were obtained at 1-minute intervals. After a baseline period, 5 patients received 60 mg intravenous lidocaine HCl; 5 received 5 mL normal saline, via epidural catheter; and 30 patients received 50 mg lidocaine HCl and 20 mcg epinephrine in 2.5, 5.0, or 7.5 mL normal saline (10 patients each). Inspiratory gasp vasoconstrictive response was defined as the percent change in perfusion from baseline produced by an inspiratory gasp. Perfusion was normalized by expressing each patient's value as a percentage of the respective baseline value.

Results. Significant increases in perfusion, of up to 169% of baseline, were seen 12 minutes after the test dose. Inspiratory gasp vasoconstrictive response showed significant changes from baseline in all test groups. The temperature change was insignificant. Control groups did not show perfusion or IGVR changes.

Conclusions. Skin perfusion and IGVR changed significantly after epidural test dose; the minimal effect of volume appears to be 5 mL of lidocaine-epinephrine solution; the presence of IGVR or perfusion changes, or both, are positive predictors of successful placement of the catheter into the epidural space; and temperature changes as observed here were not reliable predictors of proper placement of epidural catheters.

  • anesthetic technique
  • epidural
  • anesthetics
  • local
  • lidocaine
  • inspiratory gasp vasoconstrictive response (IGVR)
  • measurement technique
  • laser Doppler flowmetry

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  • Portions of this manuscript were presented at the American Society of Anesthesiologists Annual Meeting, New Orleans, LA, October 1992.

    The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the United States Government.