Canadian Journal of Anaesthesia

, Volume 44, Issue 6, pp 592–598 | Cite as

Detection of intravascular injection of regional anaesthetics in children

  • Quentin A. Fisher
  • Donald H. Shaffner
  • Myron Yaster
Reports of Investigation



Detection of intravascular injection of local anaesthetic during placement of regional blocks in children by using epinephnne-induced tachycardia or hypertension may produce false positive and false negative findings. This study evaluates ECG changes as markers of intravascular injection of local anaesthetics with epinephnne, during placement of epidural blocks in children.


Observational study in a teaching hospital of all epidural anaesthetics administered to paediatnc patients dunng one year. General anaesthesia, where used, was not controlled. An ECG rhythm strip was recorded during test dose injection and analyzed for changes in rate, rhythm, and T-wave configuration.


During the study penod, 742 paediatnc epidural blocks were administered. There were 644 caudal (284 without catheters). 97 lumbar, and one thoracic epidural anaesthetics. Satisfactory placement was achieved in 97.7% of patients. Intravascular injection was detected in 42 (5.6%) of epidural anaesthetics (3.8% and 6.7% of straight needle and catheter injections, respectively). Detection was by immediate aspiration of blood in six patients, and by heart rate increases > 10 bpm in 30. Five had heart rate decreases suggesting a baroreceptor response. Five had heart rate increases < 10 bpm that were possible responses to noxious stimuli. Of 30 patients with known intravascular injection and for whom ECG strips were available, 25 (83%) had T-wave amplitude increases > 25%. and 29 (97%) had ECG changes in T-wave or rhythm in response to the epinephrine injection. There were no false positives.


In order to reduce risks associated with epidural anaesthesia in children, epinephnne should be added to the local anaesthetic test dose, the ECG should be monitored continuously for changes in heart rate, rhythm, and T-wave amplitude. Epidural injections should be given in small increments.


Bupivacaine Test Dose Heart Rate Change Intravascular Injection Straight Needle 
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La détection de l’injection intravasculaire d’anesthésique local pendant l’administration d’un bloc régional chez l’enfant par la tachycardie et l’hypertension peut donner lieu à des faux positifs et des faux négatifs. Cette étude évalue les changements de l’ÉCG comme indices d’injection intravasculaire d’anesthésiques locaux adrénalinés pendant l’administration du bloc.


L’inventaire de toutes les anesthésies épidurales administrées à des enfants pendant une année dans un hôpital d’enseignement. Lanesthésie générale était un critère d’exclusion. Un bande de rythme ÉEG était enregistrée pendant l’injection de la dose test et examinée relativement aux changements de fréquence, de rythme et de configuration de l’onde T.


Pendant la pénode d’étude, 742 blocs épiduraux pédiatriques ont été administrés, dont 644 anesthésies caudales (284 sans cathéter). 97 lombaires et une épidurale thoracique avec succès dans 97,7% des patients. Une injection mtravasculaire est survenue au cours de 42 (5,6%) anesthésies épidurales (3,8% par l’aiguille et 7.6% par le cathéter) et a été détectée par l’aspiration immédiate de sang chez six patients et par une augmentation de la fréquence cardiaque > 10 bpm chez 30. La fréquence a diminué chez cinq patients suggérant une réponse barotropique. Cinq ont présenté des augmentations de fréquence < 10 bpm en réaction possible aux stimuli nocifs. Sur 30 patients chez qui l’injection intravasculaire était claire et chez qui des bandes de rythme étaient disponibles. 25 (83%) présentaient une augmentation de l’amplitude de l’onde T > 25%. et 29 (97%) avaient des changements de l’onde T ou du rythme en réponse à l’injection d’épinéphnne. Il n’y a pas eu de faux positifs.


Pour réduire les risques associés à l’anesthésie épidurale chez l’enfant, de l’épinéphnne devrait être ajoutée à la dose test d’anesthésique local et l’ÉCG devrait être monitoré en continu pour révéler les changements de fréquence, du rythme et d’amplitude de l’onde T. Lanesthésique local doit être administré dans l’espace épidural en petites doses répétées.


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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Quentin A. Fisher
    • 1
  • Donald H. Shaffner
    • 1
  • Myron Yaster
    • 1
  1. 1.Department of Anaesthesiology and Critical Care MedicineJohns Hopkins UniversityBaltimore

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