Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia

Anesthesia and Analgesia
David M PolanerZhaoxing Pan

Abstract

The use of local anesthetic test doses is standard practice when performing regional anesthesia. When an intravascular test dose is administered during inhaled anesthesia, the heart rate does not increase in about 25% of children; altered T-wave amplitude is a better indicator. No studies have examined the criteria for a positive result during total i.v. anesthesia (TIVA) in children. We studied the effect of a simulated positive test dose on heart rate, arterial blood pressure, and T-wave amplitude in 17 ASA physical status I or II children receiving TIVA with propofol and remifentanil. Bupivacaine 0.25% 0.1 mL/kg with epinephrine 1:200,000 was injected i.v., and vital signs and electrocardiogram were continuously monitored. Increases of heart rate and arterial blood pressure >10% and T-wave amplitude >25% of baseline were considered clinically significant changes. All subjects had increased systolic and diastolic blood pressure (30.3% +/- 11.7% and 49.3% +/- 16.7%), which peaked within 120 s. Heart rate increases >10% of baseline occurred in 73% of subjects. T-wave amplitude increased in 33.3%, was unchanged in 25%, and decreased in 41.7% of subjects. A positive test dose during TIVA is best detected by increased arterial blo...Continue Reading

References

Dec 1, 1981·Anesthesiology·D C Moore, M S Batra
Jun 1, 1997·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Q A FisherM Yaster
Mar 7, 2000·Anesthesia and Analgesia·S A Kozek-LangeneckerM Semsroth
Mar 17, 2001·Anaesthesia·A KleinsasserF Puehringer
May 25, 2002·Acta Anaesthesiologica Scandinavica·F PetitjeansJ M Saissy
Dec 6, 2005·Regional Anesthesia and Pain Medicine·Laurence E MatherLeigh A Ladd

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Citations

Sep 4, 2010·Regional Anesthesia and Pain Medicine·Andreas H TaenzerW Daniel Kovarik
Jan 5, 2011·Paediatric Anaesthesia·David M Polaner, Jessica Drescher
Jun 16, 2011·Paediatric Anaesthesia·Per-Arne Lönnqvist
Jul 23, 2011·Paediatric Anaesthesia·Valeria Mossetti, Giorgio Ivani
Nov 6, 2010·Current Opinion in Anaesthesiology

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