Phenylephrine as a simulated intravascular epidural test dose in pediatrics: A pilot study

Carlo Pancaro, Viviane G. Nasr, Jessica K. Paulus, Iwona Bonney, Alejandro F. Flores, Jonas B. Galper, Iqbal Ahmed

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background A test dose is used to detect intravascular injection during neuraxial block in pediatrics. Accidental intravascular epidural local anesthetic injection might be unrecognized in anesthetized children leading to potential life-threatening complications. In children, sevoflurane anesthesia blunts the hemodynamic response when intravascular cathecolamines are administered. No studies have explored the hemodynamics and the criteria for a positive test dose result following phenylephrine in sevoflurane anesthetized children. Methods Healthy children undergoing minor procedures were randomly assigned to receive intravenous placebo, or 5 μgâ̂™kg -1 phenylephrine (n = 11/group) during sevoflurane anesthesia. Hemodynamic response was assessed using electrocardiography, pulse oxymetry and non-invasive blood pressure monitoring for 5 min following drug administration in anesthetized patients. Results All patients receiving phenylephrine showed a decreased heart rate (HR) but not all of them met the positive criterion for test dose response. Overall, at 1 min, patients receiving phenylephrine showed a 25% decrease in HR from the baseline while an increase in blood pressure was noticed in 54% of patients receiving phenylephrine. Discussion Phenylephrine might be a future indicator of positive intravascular test dose. Further investigation is needed to find out the phenylephrine dose that elicits a reliable hemodynamic response and whether phenylephrine needs to be dose age-adjusted in order to appreciate relevant hemodynamic changes in children receiving neuraxial blocks undergoing general anesthesia.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalPaediatric Anaesthesia
Volume23
Issue number6
DOIs
StatePublished - Jun 1 2013

Fingerprint

Phenylephrine
Pediatrics
Hemodynamics
Anesthesia
Heart Rate
Blood Pressure
Injections
Local Anesthetics
General Anesthesia
Pulse
Electrocardiography
Placebos
Pharmaceutical Preparations
sevoflurane

Keywords

  • analgesia
  • anesthesia
  • epidural
  • local anesthetic toxicity
  • pediatric test dose
  • phenylephrine
  • sevoflurane

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Anesthesiology and Pain Medicine

Cite this

Pancaro, C., Nasr, V. G., Paulus, J. K., Bonney, I., Flores, A. F., Galper, J. B., & Ahmed, I. (2013). Phenylephrine as a simulated intravascular epidural test dose in pediatrics: A pilot study. Paediatric Anaesthesia, 23(6), 502-509. https://doi.org/10.1111/pan.12157

Phenylephrine as a simulated intravascular epidural test dose in pediatrics : A pilot study. / Pancaro, Carlo; Nasr, Viviane G.; Paulus, Jessica K.; Bonney, Iwona; Flores, Alejandro F.; Galper, Jonas B.; Ahmed, Iqbal.

In: Paediatric Anaesthesia, Vol. 23, No. 6, 01.06.2013, p. 502-509.

Research output: Contribution to journalArticle

Pancaro, C, Nasr, VG, Paulus, JK, Bonney, I, Flores, AF, Galper, JB & Ahmed, I 2013, 'Phenylephrine as a simulated intravascular epidural test dose in pediatrics: A pilot study', Paediatric Anaesthesia, vol. 23, no. 6, pp. 502-509. https://doi.org/10.1111/pan.12157
Pancaro C, Nasr VG, Paulus JK, Bonney I, Flores AF, Galper JB et al. Phenylephrine as a simulated intravascular epidural test dose in pediatrics: A pilot study. Paediatric Anaesthesia. 2013 Jun 1;23(6):502-509. https://doi.org/10.1111/pan.12157
Pancaro, Carlo ; Nasr, Viviane G. ; Paulus, Jessica K. ; Bonney, Iwona ; Flores, Alejandro F. ; Galper, Jonas B. ; Ahmed, Iqbal. / Phenylephrine as a simulated intravascular epidural test dose in pediatrics : A pilot study. In: Paediatric Anaesthesia. 2013 ; Vol. 23, No. 6. pp. 502-509.
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AB - Background A test dose is used to detect intravascular injection during neuraxial block in pediatrics. Accidental intravascular epidural local anesthetic injection might be unrecognized in anesthetized children leading to potential life-threatening complications. In children, sevoflurane anesthesia blunts the hemodynamic response when intravascular cathecolamines are administered. No studies have explored the hemodynamics and the criteria for a positive test dose result following phenylephrine in sevoflurane anesthetized children. Methods Healthy children undergoing minor procedures were randomly assigned to receive intravenous placebo, or 5 μgâ̂™kg -1 phenylephrine (n = 11/group) during sevoflurane anesthesia. Hemodynamic response was assessed using electrocardiography, pulse oxymetry and non-invasive blood pressure monitoring for 5 min following drug administration in anesthetized patients. Results All patients receiving phenylephrine showed a decreased heart rate (HR) but not all of them met the positive criterion for test dose response. Overall, at 1 min, patients receiving phenylephrine showed a 25% decrease in HR from the baseline while an increase in blood pressure was noticed in 54% of patients receiving phenylephrine. Discussion Phenylephrine might be a future indicator of positive intravascular test dose. Further investigation is needed to find out the phenylephrine dose that elicits a reliable hemodynamic response and whether phenylephrine needs to be dose age-adjusted in order to appreciate relevant hemodynamic changes in children receiving neuraxial blocks undergoing general anesthesia.

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