Intravenous anesthesia


Anesthesia and Pain Medicine. 2003 Sept. 7(3): 100-104
ⓒ Korean Society for Intravenous Anesthesia
The Effects of Small Test Dose of Intravenous Epinephrine on Blood Pressure and Heart Rate in Propofol-Induced Hypnosis
In Beom Choe, M.D., Sang Kyi Lee, M.D., and Ji Sun Son, M.D.
Department of Anesthesiology & Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea

Background: The 15mug of epinephrine, if injected intravascularly into awake patients undergoing regional anesthesia, should produce a noticeable increase in heart rate (20% or more) or in systolic blood pressure (15 mmHg or more) in patients taking bata-adrenergic blockers. The purpose of this study was to assess blood pressure and heart rate changes after injection of epinephrine 15mug in patients given propofol for hypnosis.
Methods: Thirty-five patients who scheduled for an elective lower extremity surgery by spinal anesthesia were divided into two groups: S (control group given saline, n = 15) and E (experimental group given epinephrine 15mug, n = 20). After spinal anesthesia, propofol was infused for sedation or hypnosis (target bispectral index [BIS] score, 60 65). Then, the S group received intravenous injection of saline 3 ml and the E group received intravenous injection of epinephrine 15mug (1:200,000, 3 ml). We checked blood pressure (BP) and heart rate (HR) immediately before and for 5 minutes after injections of saline or epinephrine.
Results: In the E group, significant increase of HR (about 27%) was observed at 1 minute after the epinephrine injection, and the significant maximal increase (about 28 mmHg) of systolic BP was observed at 2 minutes after the epinephrine injection. However, there were no significant changes in BP and HR in the S group. There were significant differences in HR (1 min.) and BP (1, 2, and 3 min.) between the groups.
Conclusions: During regional anesthesia under propofol-induced hypnosis, it is considered to be safe that close observation of hemodynamic changes for about 1 2 minutes after the test dose injection of epinephrine combined with local anesthetics should be followed by total dose administration of local anesthetics.
Key words : Epinephrine, propofol, regional anesthesia, test dose
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