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Korean Journal of Anesthesiology 2006;51(4):411-414.
DOI: https://doi.org/10.4097/kjae.2006.51.4.411   
The Efficacy of Epinephrine-Containing Test Dose during Propofol-Nitrous Oxide Anesthesia with High Dose Fentanyl.
Nam Hoon Koo, Yunseok Jeon, Yong Chul Kim, Young Jin Lim, Sanglee Park, Byung Moon Ham
Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea. limyjin@snu.ac.kr
The aim of this study is to determine the effect of high dose fentanyl on the test dose containing 15microgram epinephrine during propofol anesthesia.
One hundred patients with ASA physical status 1 were randomized to receive 2 mg/kg propofol with or without 10microgram/kg fentanyl at the induction of anesthesia (n = 50 each). Anesthesia was maintained with propofol 8 mg/kg/h and 67% nitrous oxide in oxygen. Each group of patients were further divided into a test dose group receiving 1.5% lidocaine 3 ml plus epinephrine 15microgram or a saline group receiving 3 ml of isotonic saline (n = 25 each). Heart rate (HR) and systolic blood pressure (SBP) were monitored for 4 min after intravenous injection of the study drugs.
In the propofol and the propofol-fentanyl group, the intravenous injection of the test dose produced a HR increase > or = 20 bpm (conventional HR criterion) in 25 and 23 out of the total 25 patients, respectively. Therefore, in the propofol-fentanyl group, sensitivity, specificity, positive predictive value, and negative predictive value were 82%, 100%, 100%, and 92.6%. According to the modified HR criterion (HR increase > or = 10 bpm), all the values were 100%. All patients receiving test dose developed SBP increase > or = 15 mmHg.
Our results indicate that both HR increase > or = 10 bpm or SBP increase > or = 15 mmHg are clinically applicable during propofol-nitrous oxide anesthesia with 10microgram/kg fentanyl.
Key Words: epinephrine test dose; fentanyl; propofol


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