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KMID : 0356920100580040351
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Korean Journal of Anesthesiology
2010 Volume.58 No. 4 p.351 ~ p.356
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The change of T-wave on electrocardiogram after epinephrine test dose in spinal anesthetized adults
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Lee Jeong-Woo
Kim Deok-Kyu
Choi Hyun-Ho
Kim Dong-Chan
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Abstract
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Background: This study evaluated the efficacy of a T-wave change after the IV administration of low dose epinephrine containing the test dose during spinal anesthesia.
Methods: Eighty healthy adults undergoing spinal anesthesia were enrolled in this study. The subjects were divided randomly into the following 4 groups: Group S (n = 20) received 3 ml of normal saline, group L (n = 20) received 3 ml of 1.0% lidocaine, group E5 received 3 ml of 1.0% lidocaine with epinephrine 5 μg, and group E10 received 3 ml of 1.0% lidocaine with epinephrine 10 μg. The heart rate (HR) and T-wave amplitude were measured with an electrocardiogram and systolic blood pressure (SBP) using a non-invasive method. Positive responses were defined as an increase in HR ≥ 20 bpm or SBP ≥ 15 mmHg, or a decrease in the T-wave amplitude ≥ 25%.
Results: The sensitivity (Ss), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of the HR increases were 80%, 100%, 100%, and 83%, respectively, in groups E5 and E10. For the SBP increases, the Ss, Sp, PPV, and NPV were respectively, 55%, 100%, 100%, and 70% in group E5, and 80%, 100%, 100%, and 83% in group E10. For the ≥ 25% decrease in T-wave amplitude, Ss, Sp, PPV, and NPV were respectively, 100%, 90%, 91%, and 100% in group E5, and 95%, 90%, 90%, and 95% in group E10.
Conclusions: These results suggest that a change in the T-wave amplitude is useful for detecting the unintentional IV administration of low dose epinephrine during CSEA.
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KEYWORD
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Electrocardiography, Epidural injection, Epinephrine, Lidocaine
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