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Efficacy of Simulated Epinephrine-Containing Epidural Test Dose After Intravenous Atropine During Isoflurane Anesthesia in Children
  1. Navil F. Sethna, M.B., Ch.B.,
  2. Lorna Sullivan, R.N.,
  3. Alan Retik, M.D.,
  4. Francis X. McGowan, M.D.,
  5. James Di Canzio, M.S. and
  6. David Zurakowski, Ph.D.
  1. From the Departments of Anesthesia (N.F.S., L.S., F.X.M.), Urology (A.R.), and Biostatistics (J.D.C., D.Z.), Children’s Hospital, Harvard Medical School, Boston, Massachusetts.
  1. Reprint requests: Navil F. Sethna, M.B., Ch.B., Pain Treatment Service, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: Sethna{at}


Background and Objectives A double-blind, randomized study was performed to investigate heart rate (HR) and blood pressure responses to 2 doses of intravenous (IV) epinephrine (0.5 and 0.75 μg/kg) in 61 children, ages 3 months to 12 years.

Methods Anesthesia was maintained with isoflurane (age-adjusted 1 minimal alveolar concentration [MAC]) in oxygen. All patients received IV atropine (10 μg/kg) and 5 minutes later were randomized to receive IV solutions (0.1 mL/kg) containing 1% lidocaine (n = 19, group I) with saline; lidocaine 1% with epinephrine 0.5 μg/kg (n = 21, group II); or lidocaine 1% with epinephrine 0.75 μg/kg (n = 21, group III). HR was recorded at 0, 15, 30, 45, 60, 90 seconds, and 2, 3, 4, and 5 minutes after test-dose injection. Systolic blood pressure (SBP), diastolic blood pressure, and end-tidal carbon dioxide were recorded at steady-state isoflurane anesthesia, after the injection of atropine, and at 45-second intervals after test-dose injections.

Results Median maximum increases in HR were similar in groups II and III at 19 and 22 beats per minute (beats/min), respectively. An HR increase of ≥10 beats/min was observed in 19 of 21 patients who received 0.5 μg/kg epinephrine and 21 of 21 patients receiving 0.75 μg/kg. None of the patients in group I developed HR increases ≥10 beats/min. SBP increased ≥15 mm Hg in 17 of 21 patients in group II and 19 of 21 in group III. No dysrhythmias or T-wave amplitude change was noted.

Conclusions A simulated epidural test dose containing lidocaine 1 mg/kg with epinephrine 0.75 μg/kg, administered IV following atropine, may reliably increase HR to indicate unintentional injection into epidural vessels of children anesthetized with 1 MAC isoflurane.

  • Anesthetics
  • Isoflurane
  • Children
  • Epidural test dose
  • Epinephrine
  • Atropine

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  • Previously presented in part at the American Society of Anesthesiologists Annual Meeting in New Orleans, LA, October 19-23, 1996.