Abstract
Purpose
To determine the hemodynamic responses to, and the efficacy of epinephrine-containing epidural test doses, during sevoflurane anesthesia, based on the conventional heart rate (HR) increase ≥20 beats·min−1, the modified HR increase if ≥ 10 beats·min−1, and the systolic blood pressure (SBP) increase 15 mmHg criteria.
Methods
One hundred and twenty patients were randomised to receive sevoflurane 0.5, 1 or 2% end-tidal (n = 40 each) and nitrous oxide 67% in oxygen aftertracheal intubation. Each group of patients was further divided into groups receiving 3 ml lidocaine 1.5% plus 15 μg epinephrine (1:200,000) iv, or 3 ml normal saline (n = 20 each). The HR and SBP were monitored for four minutes after injection of the study drug.
Results
Intravenous injection of the test dose produced HR increases ≥20 beats·min−1 in 18 (90%), 16 (80%) and 14 (70%) patients at sevoflurane concentrations at 0.5, 1 and 2%, respectively, while those receiving saline developed no HR changes. Based on the modified HR criterion, sensitivity, specificity, and positive and negative predictive values were all 100% under sevoflurane concentrations of 0.5 and 1%, but not 2%. On the other hand, all patients in the test dose groups and none in the saline groups developed SBP ≥ 15 mmHg, ensuring 100% efficacy based on the conventional SBP criterion under all sevoflurane concentrations studied. In all patients receiving the intravenous test dose, peak HR occurred 30–45 sec earlier than that of SBP.
Conclusion
During stable sevoflurane anesthesia, peak HR increase ≥ 10 beats·min−1 should be regarded as a positive response with end-tidal sevoflurane concentration ≤ 1%, and peak SBP increase ≥ 15 mmHg is applicable at sevoflurane concentrations between 0.5 and 2%.
Résumé
Objectif
Déterminer les réponses hémodynamiques à des doses tests péridurales contenant de l’épinéphrine et en vérifier l’efficacité pendant l’anesthésie au sévoflurane. Les essais sont basés sur l’augmentation habituelle de la fréquence cardiaque(FC)> 20 battements·min−1, l’augmentation modifiée de la FC si > 10 battements·min−1 et le critère d’accroissement > 15 mmHg de la tension artérielle systolique (TAS).
Méthode
Cent vingt patients ont été répartis au hasard et ont reçu du sévoflurane 0,5, 1 ou 2 % (fin d’expiration) (n = 40 dans chaque groupe) et un mélange de protoxyde d’azote, à 67 %, et d’oxygène après l’intubation endotrachéale. Chaque groupe a ensuite été divisé en sous-groupes à qui on a administré 3 ml de lidocaïne 1,5 % et 15μg d’épinéphrine (1:200 000)iv, ou 3 ml de solution salée (n = 20 chacun). La FC et la TAS ont été surveillées pendant quatre minutes après l’injection du médicament étudié.
Résultats
L’injection intraveineuse de la dose test a produit une augmentation de la FC> 20 battements-min−1 chez 18 (90 %), 16 (80 %) et 14 (70 %) patients pour des concentrations de sévoflurane de 0 5, 1 et 2 %, respectivement, tandis que ceux qui ont reçu une solution salée n’ont pas subi de changement de FC. Sur la base du criète modifié de FC, la sensibilité, la spécificité et les valeurs prédictives positives et négatives ont été de 100 % avec les concentrations de sévoflurane de 0,5 % et de 1 % mais non avec la concentration de 2 %. Par ailleurs, tous les patients qui ont reçu des doses tests ont développé une TAS > 15 mmHg, contrairement aux patients qui ont reçu une solution salée, ce qui assure 100 % d’efficacité, basée sur le critère habituel de TAS, de toutes les concentrations de sévoflurane étudiées. Chez tous les patients qui ont reçu des doses tests intraveineuses, on a enregistré la FC maximale 30–45 s plus tôt que celle de la TAS.
Conclusion
Pendant une anesthésie stable au sévoflurane, l’accroissement de la FC > 10 battements·min−1 devrait être considéré comme une réaction positive avec des concentrations de sévoflurane de fin d’expiration I %, et l’accroissement de TAS maximale > 15 mmHg se manifeste à des concentrations de sévoflurane entre 0,5 et 2 %.
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Takahashi, S., Tanaka, M. Reduced efficacy of simulated epidural test doses in sevoflurane-anesthetized adults. Can J Anesth 46, 433–438 (1999). https://doi.org/10.1007/BF03012942
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DOI: https://doi.org/10.1007/BF03012942