Detection of intravascular injection of regional anaesthetics in children

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
Q A FisherM Yaster

Abstract

Detection of intravascular injection of local anaesthetic during placement of regional blocks in children by using epinephrine-induced tachycardia or hypertension may produce false positive and false negative findings. This study evaluates ECG changes as markers of intravascular injection of local anaesthetics with epinephrine, during placement of epidural blocks in children. Observational study in a teaching hospital of all epidural anaesthetics administered to paediatric patients during one year. General anaesthesia, where used, was not controlled. An ECG rhythm strip was recorded during test dose injection and analyzed for changes in rate, rhythm, and T-wave configuration. During the study period, 742 paediatric epidural blocks were administered. There were 644 caudal (284 without catheters), 97 lumbar, and one thoracic epidural anaesthetics. Satisfactory placement was achieved in 97.7% of patients. Intravascular injection was detected in 42 (5.6%) of epidural anaesthetics (3.8% and 6.7% of straight needle and catheter injections, respectively). Detection was by immediate aspiration of blood in six patients, and by heart rate increases > 10 bpm in 30. Five had heart rate decreases suggesting a baroreceptor response. Five had...Continue Reading

References

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Citations

Jun 1, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·S Takahashi, M Tanaka
Jun 1, 1997·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·J Lerman
Sep 29, 2005·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Jin-Tae KimKook-Hyun Lee
Aug 10, 2000·Anesthesiology Clinics of North America·D A Markakis
May 22, 2001·Paediatric Anaesthesia·J D Tobias
May 27, 2003·British Journal of Anaesthesia·G Cucchiaro, L A Rhodes
Jul 7, 2009·Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie·F SemjenM Bordes
Jul 23, 2008·Journal of Pediatric Urology·Sabine Kost-ByerlyJohn P Gearhart
Oct 8, 2009·Paediatric Anaesthesia·Elsa VargheseKoneru Veera Raghava Chowdary
Mar 29, 2013·Paediatric Anaesthesia·Carlo PancaroIqbal Ahmed
Jan 5, 2011·Paediatric Anaesthesia·David M Polaner, Jessica Drescher
Sep 21, 2010·Paediatric Anaesthesia·Erica P Lin, Lori A Aronson
Sep 9, 2015·Paediatric Anaesthesia·Yukako AbukawaMakoto Ozaki
Jun 3, 2000·Pediatric Clinics of North America·B StevensL S Franck
Mar 15, 2002·Anesthesiology Clinics of North America·Santhanam Suresh, Melissa Wheeler
Apr 9, 2010·European Journal of Anaesthesiology·Myron Yaster
Oct 22, 2008·The Clinical Journal of Pain·Michelle L CzarneckiSteven J Weisman
Jan 23, 2008·European Journal of Anaesthesiology·L Timmerman, J H A M Megens
Jul 21, 2005·Paediatric Anaesthesia·J William Sparks, Christian Seefelder
Aug 17, 2005·Paediatric Anaesthesia·Adrian T BösenbergLars E Larsson
Sep 25, 2002·Paediatric Drugs·Joel B Gunter
Feb 24, 2006·Anesthesia and Analgesia·Joanne Guay
Jan 23, 2003·Anesthesia and Analgesia·James C Eisenach, Tony L Yaksh
Jul 23, 2011·Paediatric Anaesthesia·Valeria Mossetti, Giorgio Ivani
Sep 12, 2013·Anesthesia and Analgesia·Donald H ShaffnerJayant K Deshpande
Oct 5, 2006·Current Opinion in Anaesthesiology·J D Tobias
Oct 5, 2006·Current Opinion in Anaesthesiology·Christian Seefelder

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