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Background and Aims The Tsui test, also known as the epidural electrical stimulation test (EEST) is a simple, safe, and reliable method for objective assessment of correct thoracic epidural catheter placement with a sensitivity and specificity of 80-100% to 91.6-100%. Test uses low-amplitude electrical current applied to an epidural catheter and conducted through a column of saline to elicit a motor response
Methods We present a 61-year-old female, undergoing the repair of recurrent ventral incisional and parastomal hernia. After obtaining written consent the patient was positioned siting on the bed. The epidural was placed at T9 level. A spring-loaded catheter was advanced without any resistance into the epidural space and Tsui test was performed to define the tip of the catheter. A positive motor response was detected at 3mA at patient’s upper abdomen. Several seconds after initiation of nerve stimulation patient became bradycardic. Heart rate decreased from 61 to 38 bpm and blood pressure decreased from 153/78 to 92/38. Pacer spikes were noted on a monitor preceding each QRS complex. The patient remained bradycardic and did not recover immediately after the stoppage of electrical stimulation. Glycopyrrolate 0.2 mg was administered which improved the patient’s symptoms. The patient tolerated the test dose and epidural throughout the course of her stay. The patient was discharged home without any complications on post op day 3rd.
Conclusions We suggest that immediate availability of rescue medications like glycopyrrolate, atropine, along with vasopressors in patients undergoing epidural catheter placement using Tsui test as additional safety measure should be followed routinely.
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