1. © The Efficacy Of Plethysmographic Pulse Wave Amplitude As An Indicator For Intravascular Injection Of Epinephrine-Containing Epidural Test Dose In Anesthetized Adults Mowafi, HA LIPPINCOTT WILLIAMS WILKINS, ANESTHESIA AND ANALGESIA; pp: 1506-1511; Vol: 101 King Fahd University of Petroleum & Minerals http://www.kfupm.edu.sa Summary In this study, I evaluated the efficacy of plethysmographic pulse wave amplitude (PPWA) in detecting intravascular injection of a simulated epidural test dose containing 15 mu g of epinephrine in adults during either sevoflurane or isoflurane inhaled anesthesia and compared its reliability to the classical heart rate (HR; positive if >= 10 bpm) and systolic blood pressure (SBP; positive if >= 15 mm Hg) criteria. Eighty patients were randomized to receive either 1 mean alveolar anesthetic concentration of sevoflurane or 1 mean alveolar anesthetic concentration of isoflurane (n = 40 for each anesthesia group). Patients in each anesthesia group were further randomized to receive either 3 mL of 1.5% lidocaine containing 15 mu g of epinephrine IV or 3 mL of saline IV (n = 20 each). HR, SBP, and PPWA were monitored for 5 min after injection. Injection of the test dose resulted in peak PPWA decrease by 61% +/- 17% and 58% +/- 15% at 61 +/- 12 s and 63 +/- 13 s in the sevoflurane and isoflurane groups, respectively. Positive PPWA criterion, as determined from peak increases during saline administration, was a decrease in PPWA >= 10%. Using this value, the sensitivity, specificity, positive predictive, and negative predictive values of PPWA were 100% in both anesthetic groups. On the contrary, sensitivities of 85% and 95% were obtained based on FIR criterion in the sevoflurane and isoflurane patients, respectively, and a sensitivity of 90% was Copyright: King Fahd University of Petroleum & Minerals; http://www.kfupm.edu.sa

2. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. © obtained in both anesthesia groups on the basis of SBP criterion. In conclusion, PPWA is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose. References: AKATA T, 1995, CAN J ANAESTH, V42, P1040 ALAM TA, 2005, EUR J VASC ENDOVASC, V29, P269, DOI 10.1016/j.ejvs.2004.12.019 BLANC VF, 1993, CAN J ANAESTH, V40, P271 DAHL JB, 1994, ACTA ANAESTH SCAND, V38, P557 DORLAS JC, 1985, BRIT J ANAESTH, V57, P524 DUNET F, 2004, CAN J UROL, V11, P2200 EICHHORN JH, 1986, JAMA-J AM MED ASSOC, V256, P1017 GLANTZ SA, 1992, PRIMER BIOSTATISTICS, P212 GUINARD JP, 1990, ANESTHESIOLOGY, V73, P386 HAGER H, 2003, ANESTHESIOLOGY, V99, A593 HERTZMAN AB, 1938, AM J PHYSIOL, V124, P328 HOFFMAN BB, 1996, GOODMAN GILMANS PHAR, P199 LEE PKW, 2000, ARCH PHYS MED REHAB, V81, P1587 LIU SS, 1996, ANESTHESIOLOGY, V84, P81 MARSZALEK A, 2000, MED PR, V51, P299 MOWAFI HA, 2005, ANESTH ANALG, V101, P584, DOI 10.1213/01.ANE.0000157571.00717.08 MULROY MF, 1997, ANESTH ANALG, V85, P1346 MURRAY WB, 1996, J CLIN MONITOR, V12, P365 TAKAHASHI S, 1999, CAN J ANAESTH 1, V46, P433 TANAKA M, 1995, ANESTH ANALG, V80, P310 TANAKA M, 1995, ANESTH ANALG, V81, P987 TANAKA M, 1999, ANESTH ANALG, V89, P32 For pre-prints please write to: mowafi@hotmail.com Copyright: King Fahd University of Petroleum & Minerals; http://www.kfupm.edu.sa