Biomedical subjects

Toshiaki Nishikawa

Publications and source records attributed to Toshiaki Nishikawa.

At least 19 recordsLinked to original sources

PubMed2006

Effects of sevoflurane anesthesia on carotid-cardiac baroreflex responses in humans.

Sevoflurane depresses cardio-vagal baroreflex gain (ability of vagally mediated R-R interval response to arterial blood pressure change). We examined the effects of sevoflurane anesthesia on maximum buffering capacity of vagally mediated hemodynamic control (baroreflex range) by examining the entire stimulus-response baroreflex relation. Electrocardiogram and invasive arterial blood pressure were monitored in 11 healthy volunteers. Carotid-cardiac baroreflex responses were elicited by increasing neck chamber pressure (external pressure applied over the bilateral carotid sinuses) to 40 mm Hg for 5 heartbeats followed by decreasing chamber pressure by successive 15-mm Hg R-wave triggered decrements to -65 mm Hg during held expiration. R-R intervals were plotted as functions of preceding carotid distending pressure. Range, maximum gain, and operational point (relative position of the resting set point within the entire baroreflex response curve) were determined at conscious baseline, during 2% (end-tidal) sevoflurane anesthesia, without and with phenylephrine infusion to maintain conscious arterial blood pressure, and at 30, 60, 120, and 180 min after emergence from anesthesia. Sevoflurane anesthesia significantly depressed maximum gain (from 3.84 +/- 0.99 to 1.04 +/- 0.40 ms/mm Hg [mean +/- sd]; P < 0.001) and range (from 207 +/- 43 to 52 +/- 19 ms; P < 0.001) of the reflex relation, both of which recovered at 120 and 180 min after emergence. Phenylephrine infusion only partially restored these variables. The operational point was unchanged throughout the study. Our results indicate that maximum cardio-vagal compensatory response to buffer hemodynamic perturbation is depressed during sevoflurane anesthesia. Sevoflurane-induced hypotension, which produced vagal withdrawal, did not play an important role in depressing cardio-vagal reflex function.

Adult↗

PubMed2006

Beta-adrenoreceptor antagonists attenuate brain injury after transient focal ischemia in rats.

Beta-adrenoreceptor antagonists experimentally reduce cardiac and renal injury after ischemia and are also clinically useful for myocardial infarction and severe burns. In addition, beta-adrenoreceptor antagonists provide neuroprotective effects after focal cerebral ischemia in experimental settings. We conducted the present study to compare the neuroprotective effects of several beta-adrenoreceptor antagonists in rat transient focal cerebral ischemia. Halothane-anesthetized normothermic adult male Sprague-Dawley rats were subjected to 2 h of middle cerebral artery occlusion using the intraluminal suture technique confirmed by laser Doppler flowmetry. Rats received an IV infusion of saline 0.5 mL/h, propranolol 100 microg x kg(-1) x min(-1), carvedilol 4 microg x kg(-1) x min(-1), esmolol 200 microg x kg(-1) x min(-1), or landiolol 50 microg x kg(-1) x min(-1) (n = 6 in each group). Infusion was initiated 30 min before middle cerebral artery occlusion and continued for 24 h. Additional rats received esmolol 50 microg x kg(-1) x min(-1) or landiolol 10 microg x kg(-1) x min(-1) intrathecally (IT) via the cisterna magna (n = 5 in each group), according to the same experimental protocol. The neurological deficit score was evaluated at 22 h after reperfusion, and the brains were removed and stained with triphenyltetrazolium chloride for evaluation of infarct volume. Additional rats that received saline, esmolol, and landiolol IV (n = 6 in each group) were allowed to survive for 7 days followed by measurement of infarct size. Neurological deficit scores were smaller in rats treated with propranolol-IV, carvedilol-IV, esmolol-IV, landiolol-IV, esmolol-IT, and landiolol-IT compared with saline-treated rats (P < 0.05). Cortical and striatum infarct volumes were less in the rats receiving beta-adrenoreceptor antagonists via either IV or IT than in saline-treated rats (P < 0.05). We conclude that beta-adrenoreceptor antagonists improve neurological and histological outcomes after transient focal cerebral ischemia in rats independent of administration route.

Adrenergic beta-Antagonists↗

PubMed2006

[Organ protection by anesthetics: preface and comments].

Numerous investigations have been performed, focusing on the anesthetic toxicity such as hepatotoxity or nephrotoxicity, for more than 40 years. However, recent basic researche has demonstrated several beneficial effects of anesthetics, including organ protection against ischemia and subsequent reperfusion, and anesthetic preconditioning, as well as clarified mechanisms of acute and delayed cell death, and apoptosis. In this special issue, four experts have provided new relevant information concerning brain, heart, lung, and liver protection by anesthetics, respectively.

Anesthetics↗

PubMed2006

[Successful epidural anesthesia using 120 mm epidural needle for cesarean section in a morbidly obese parturient with body mass index 50.2 kg x m(-2)].

In a morbidly obese parturient, epidural anesthesia is occasionally difficult because of great distance from the skin to the epidural space, and difficulty in identification of appropriate landmarks. We successfully managed cesarean section in a morbidly obese parturient with body mass index of 50.2 kg x m(-2) under epidural anesthesia. We used a 17 G custom-made epidural needle 120 mm long (Hakko, Tokyo, Japan), and the depth from the skin to the epidural space was 95 mm. We conclude that an extremely long epidural needle was useful in a morbidly obese parturient for overcoming the difficulties in epidural puncture and avoiding general anesthesia-related complications.

Adult↗

PubMed2005

Landiolol attenuates the cardiovascular response to tracheal intubation.

PURPOSE: The objective of this prospective study was to compare the cardiovascular responses with or without landiolol to the induction of general anesthesia and tracheal intubation. METHODS: Twenty-two patients were randomly allocated to receive a loading dose of landiolol 125 microg kg(-1) min(-1) for 1 min followed by an infusion at 40 microg kg(-1) min(-1) for 4 min, or placebo. Four minutes after landiolol or placebo was started, propofol and succinylcholine were administered. Laryngoscopy and tracheal intubation were performed 1 min after the administration of succinylcholine. Heart rate and blood pressure were measured noninvasively every minute. RESULTS: A significant attenuation of the heart rate and blood pressure response were seen in the landiolol group for 3 min after intubation. Heart rate and systolic blood pressure in the landiolol group were decreased for 2 min before intubation and just before intubation compared with baseline, respectively. CONCLUSION: Continuous administration of landiolol before tracheal intubation results in the attenuation of cardiovascular response for tracheal intubation.

Adrenergic beta-Antagonists↗

PubMed2005

Unsuspected subglottic stenosis in a 5-year-old scheduled for elective surgery.

Acquired laryngotracheal stenosis is one of the serious complications of tracheal intubation. We report a case of unsuspected subglottic stenosis in a 5-year-old, who was scheduled for elective surgery and whose trachea had been intubated for 35 days in early infancy. Difficulties with airway management resulted in postponement of scheduled surgery. In the preanesthetic evaluation of suspected subglottic stenosis, high-voltage radiography of the neck is a useful, less-invasive, and inexpensive examination.

Adult↗

PubMed2005

The concentration-dependent effects of general anesthesia on spontaneous baroreflex indices and their correlations with pharmacological gains.

Beat-to-beat assessment of spontaneously occurring fluctuations in heart rate and arterial blood pressure allows noninvasive determination of cardiovagal function, but little is known regarding the effects of general anesthesia on spontaneous baroreflex (SBR) indices. We examined (a) concentration-dependent effects of sevoflurane on SBR indices, heart rate variability (HRV), and blood pressure variability and (b) correlation and agreement between pharmacological baroreflex gains and SBR indices during sevoflurane anesthesia. Continuous electrocardiogram and invasive arterial blood pressure were monitored in nine healthy volunteers before, during, and for 3 h after sevoflurane anesthesia, during which end-tidal sevoflurane was maintained at 0.7%, 1.4%, and 2.0% in random sequences. We derived three SBR indices (sequence method, alpha-index, and low-frequency transfer function) and compared them with pressor and depressor test gains by the pharmacological method. HRV and blood pressure variability were analyzed at a fixed respiratory rate (12 breaths/min) in awake and anesthetized conditions. Except for low-frequency transfer function, SBR indices were depressed by sevoflurane and remained depressed for 30 min after emergence from anesthesia, compared with the conscious baseline value. Spontaneous sequence indices and high- and low-frequency powers of HRV demonstrated concentration-dependent depression. Pharmacological gains and SBR indices during anesthesia generally correlated well, but Bland-Altman analysis revealed that SBR indices had limits of agreement as large as the baroreflex gain itself. These data suggest that spontaneous indices are inadequate estimates of, and are inconsistent with, the pharmacological baroreflex gain during sevoflurane anesthesia.

Adult↗

PubMed2005

Inhibition of poly (ADP-ribose) synthetase improves pulmonary arterial endothelium-dependent relaxation after ischemic-reperfusion injury of splanchnic artery in rats.

The role of poly (adenosine diphosphate-ribose) synthetase (PARS) in the contractile and relaxant responses of pulmonary arteries injured by ischemia and reperfusion (IR) of splanchnic artery has not been evaluated. We examined these responses by using 3-aminobenzamide, a pharmacological inhibitor of PARS. IR models in rats were induced by clamping the superior mesenteric artery for 60 min, followed by release of the clamp for 60 min. In the 2 treated groups, 5 or 10 mg/kg of 3-aminobenzamide was administered as an IV bolus at 10 min before reperfusion, followed by infusion rates of 5 and 10 mg.kg(-1).h(-1), respectively, during the period of reperfusion (IR + PARS inhibitor 5 and 10 groups). In the vehicle-treated group, 3-aminobenzamide was not given, but IV saline was administered (IR group). In the control group, surgery was performed, but the superior mesenteric artery was not occluded (sham group). The pulmonary arteries were isolated, and effects of drugs were evaluated in vitro. The IR group showed no attenuation of the contractile responses of the pulmonary artery to phenylephrine. The relaxant responses to endothelium-dependent vasodilators, acetylcholine, and A23187 in the IR group were significantly inhibited when compared with the sham group. The reduction in the relaxant response to endothelium-dependent vasodilators was improved in the IR + PARS inhibitor 5 and 10 groups when compared with the IR group. We concluded that IR attenuated the relaxant responses of the pulmonary artery to endothelium-dependent vasodilators and that PARS inhibitors ameliorate the reduction in the relaxant response.

Acetylcholine↗

PubMed2005

[Severe airway obstruction relieved by sedation using sevoflurane in a pediatric patient with tracheobronchomalacia].

A 3-month-old baby with trisomy 18 syndrome was scheduled for tracheostomy under general anesthesia because of the prolonged tracheal intubation. Immediately after transferring the patient to the operating table, the patient suddenly began crying and coughing, resulting in severe hypoxia. The patient's lungs could not be ventilated by manual and positive pressure ventilation, and airway obstruction could not be relieved until the respiratory effort spontaneously decreased. We started to administer sevoflurane on the recommendation of pediatricians who had successfully treated the patient with sedation using either midazolam or trichlorethylphosphate in similar situations. After sevoflurane administration, the sedated patient never developed the respiratory effort, and the lungs could be ventilated by manual and positive pressure ventilation without difficulty. The patient was diagnosed as tracheobronchomalacia as a result of intraoperative flexible bronchoscopy performed through tracheostomy tube, revealing significant narrowing of both the trachea and mainstem bronchus lumens. Sedation using sevoflurane may be helpful in maintaining airway patency in the pediatric patient with tracheobronchomalacia.

Airway Obstruction↗

PubMed2005

[Transient right bundle branch block during anesthesia].

Transient right bundle branch block occasionally occurs under anesthesia. We report a case of heart rate dependent right bundle branch block during sevoflurane anesthesia. A 74-year-old man was scheduled for partial hepatectomy. Past medical history was unremarkable, and preoperative electrocardiogram showed no conduction abnormalities. Operation was performed with epidural and general anesthesia. Five hours after induction of general anesthesia, complete right bundle branch block (CRBBB) occurred gradually without any hemodynamic changes. Although CRBBB persisted in his electrocardiogram (ECG) during surgery, recovery to normal conduction was observed 8 hours after surgery. The 12-lead ECG after disappearance of CRBBB was normal. There was no change in his vital signs and subjective symptoms. Serum level of creatine phosphokinase (CPK) isoenzyme was within normal ranges, and change of ventricular conduction corresponded with the change of heart rate. These observations suggest that transient CRBBB in this case was rate dependent.

Aged↗

PubMed2005

[Effects of oral clonidine premedication on the heart rate response to intravenous atropine during propofol anesthesia].

BACKGROUND: Propofol induces suppression of the sympathetic nervous activity, and attenuates the heart rate responses to intravenous atropine. Similarly, clonidine suppresses the heart rate response to intravenous atropine under awake and enflurane-anesthetized patients. The purpose of this study is to evaluate effects of clonidine on the heart rate response to atropine under propofol anesthesia. METHODS: Thirty-two adults patients were randomly assigned to one of two groups. Clonidine group (n=16) patients received oral clonidine 5 microg x kg(-1) and famotidine 20 mg, and the control group (n=16) patients received oral famotidine alone 90 minutes before anesthesia. After tracheal intubation, anesthesia was maintained with propofol at the effect site concentration of 3 microg x ml(-1) in air and oxygen using the TCI system. All patients received incremental doses of IV atropine 5 microg x kg(-1) over 5 s at 2-min intervals until heart rate increased > 20 beats x min(-1) from baseline values or until atropine 40 microg x kg(-1) was given. RESULTS: Although heart rate response to atropine 5-25 microg kg(-1) was similar between the two groups, heart rate response to atropine 30 microg x kg(-1) in the clonidine group was smaller than that in the control group (P<0.05). When the atropine 40 microg x kg(-1) was administered, heart rate increased > 20 beats x min(-1) in all patients of the control group, but 62.5% of patients in the clonidine group (P< 0.05). CONCLUSIONS: Oral clonidine premedication attenuates the heart rate responses to IV atropine under propofol anesthesia.

Administration, Oral↗

PubMed2004

Anesthetic management of cardiac tamponade after dual-chamber implantable cardioverter defibrillator implantation in a patient with dilated cardiomyopathy.

We report a case of cardiac tamponade in a patient with dilated cardiomyopathy after undergoing dual-chamber implantable cardioverter-defibrillator (ICD) implantation. General anesthesia was required for subxiphoid pericardiotomy. Although the occurrence rate of adverse events with ICDs has been reported to be high, the acute onset of significant cardiac tamponade is uncommon as a short-term complication of ICD implantation. We describe our anesthetic management of cardiac tamponade in the ICD patient with dilated cardiomyopathy.

Adult↗

PubMed2004

The effects of cervical and lumbar epidural anesthesia on heart rate variability and spontaneous sequence baroreflex sensitivity.

A high level of neuroaxial block may produce profound bradycardia and hypotension, possibly as a result of an imbalance between sympathetic and parasympathetic control of heart rate. We designed this study to test the hypothesis that cervical epidural anesthesia would increase the high-frequency (HF) component of heart rate variability (HRV) as a result of cardiac sympathectomy, whereas lumbar epidural anesthesia would cause sympathetic predominance. HRV and spontaneous baroreflex (SBR) sensitivity were assessed before and after cervical and lumbar epidural anesthesia by using plain 1.5% lidocaine (median upper/lower sensory block: C3/T8 for cervical and T11/L5 for lumbar) in healthy patients (n = 10 each). Electrocardiogram and noninvasive beat-to-beat arterial blood pressure were monitored. HRV was analyzed by using fast Fourier transformation. Least-square regression analysis relating R-R interval and systolic blood pressure during spontaneous fluctuation was performed to obtain SBR sensitivities. Cervical epidural group patients were significantly older (P < 0.01) and taller (P < 0.01). Cervical epidural anesthesia attenuated HF (0.15-0.4 Hz) and low-frequency (0.04-0.15 Hz) power of HRV with concomitant reductions in up- and down-sequence SBR sensitivities, suggesting decreased vagal modulation of heart rate. Lumbar epidural anesthesia resulted in a significant increase in the low-frequency/HF ratio of HRV and unchanged SBR indices, suggesting sympathetic predominance. HF power correlated well with SBR sensitivities under most of our study conditions. Respiratory rates and Paco(2) were unchanged by either epidural technique. Our results indicate that cervical, but not lumbar, epidural anesthesia depresses phasic and tonic dynamic modulation of the cardiac cycle by the vagal nerve in conscious humans.

Adult↗

PubMed2004

[Changes in intracuff pressure of endotracheal tubes permeable or resistant to nitrous oxide and incidence of postoperative sore throat].

BACKGROUND: We assessed the nitrous oxide (N2O) gas-barrier properties of a new endotracheal tube cuff, the Profile Soft-Seal Cuff (Resistant: R) (Sims Portex, Kent, UK). METHODS: The tracheas of randomly selected patients were intubated with the Profile Cuff (Permeable: P) (Sims Portex) tuble or with Portex Soft-Seal Cuff (R) (n=20 each) endotracheal tube. Cuffs were inflated with air, and intracuff pressure was measured during anesthesia using 67% N2O. Postoperative sore throat was assessed. In addition, the volume-pressure relationship of the cuff was determined in vitro. RESULTS: Cuff pressure increased gradually during anesthesia in both groups. The mean cuff pressure of the group R was significantly lower than that of the group P from 10 minutes to 230 minutes. The inflated gas and the deflated gas were not significantly different in both groups. The incidence of postoperative sore throat was not significantly different between the two groups. In vitro, the mean cuff pressure of the group R was significantly lower than that of the group P. CONCLUSIONS: The difference of cuff pressure is considered due to the difference in cuff compliance.

Anesthesia, General↗

PubMed2003

Influence of menstrual cycle on baroreflex control of heart rate: comparison with male volunteers.

This study was designed to determine baroreflex control of heart rate (HR) to hypotensive and hypertensive stimuli during the early follicular (EF), preovulation (PreOV), and midluteal (ML) phases of the menstrual cycle and to test the hypothesis that cardiovagal reflex responses to hypertensive stimuli would be altered depending on the plasma estradiol levels in healthy women. In addition, these results were compared with those of male volunteers. Fifteen healthy women with regular menstrual cycles and thirteen male volunteers were recruited. Cardiovagal baroreflex sensitivity was defined as the slope of the linear portion relating R-R interval and systolic blood pressure triggered by bolus injections of nitroprusside and phenylephrine, from the overshoot phase of the Valsalva maneuver, and during spontaneous fluctuations. Three measurements were averaged in each test as a representative at each phase, and the order of phases was counterbalanced. Baroreflex sensitivities by the phenylephrine pressor test and Valsalva maneuver during the PreOV phase were significantly greater than those during the EF and ML phases but were similar to those of men. Depressor test sensitivities by nitroprusside and down-sequence spontaneous cardiac baroreflex sensitivity during the EF phase were significantly greater than those of the ML phase and of men. Significant correlations were observed between plasma estradiol concentrations and baroreflex sensitivities assessed by phenylephrine and the Valsalva maneuver. Our results indicate that baroreflex control of HR is altered during the regular menstrual cycle, and estradiol appears to exert cardiovagal modulation in healthy women.

Adult↗

PubMed2003

Hemodilution does not alter arterial baroreflex control of heart rate in anesthetized dogs.

UNLABELLED: The cardiovascular effects of acute normovolemic hemodilution (ANH) are characterized by increased cardiac output and decreased systemic vascular resistance. However, whether arterial baroreflex function is altered by ANH remains undetermined. We assigned 23 anesthetized, mechanically ventilated dogs to mild ANH (hemoglobin, 7-8 g/dL; n = 11) or profound ANH (hemoglobin, 4-5 g/dL; n = 12) achieved by phlebotomy and simultaneous exchange with lactated Ringer's solution at 1:3 ratio to maintain constant central venous pressure and pulmonary artery occluded pressure. Baroreflex sensitivity was assessed by measurements of RR intervals of the electrocardiogram and mean arterial blood pressure (MAP) through a femoral artery catheter. Baroreflex responses were triggered by bolus IV injections of phenylephrine (25-75 micro g) and nitroprusside (50-100 micro g). The linear portion of the baroreflex curves relating RR intervals and MAP were used to determine baroreflex sensitivities. Compared with the predilution period, both ANH groups had significant increases in cardiac output and decreases in systemic vascular resistance (P < 0.01), whereas MAP and heart rate (HR) remained unchanged. However, no significant difference was detected between pre-ANH and post-ANH baroreflex sensitivities in either group. Our results indicate that arterial baroreflex control of HR is preserved during ANH to a hemoglobin concentration of 4-5 g/dL in anesthetized dogs. IMPLICATIONS: Acute normovolemic hemodilution may be preoperatively used to minimize the requirement of allogeneic blood products during major surgery. We found that baroreflex function is preserved during mild (hemoglobin concentration, 7-8 g/dL) and profound hemodilution (hemoglobin concentration, 4-5 g/dL) in pentobarbital-anesthetized dogs.

Anesthesia↗

PubMed2003

Propofol-nitrous oxide anesthesia enhances the heart rate response to intravenous isoproterenol infusion.

UNLABELLED: Heart rate (HR) response to IV atropine is attenuated during propofol-nitrous oxide (N(2)O) anesthesia. We studied the effects of propofol-N(2)O anesthesia on isoproterenol-induced HR changes. The control group (n = 15) received no propofol and no N(2)O. Patients in the propofol-N(2)O group (n = 21) received IV propofol 2.5 mg/kg over 1 min followed by a continuous infusion of propofol 10 mg x kg(-1) x h(-1). After tracheal intubation, anesthesia was maintained with propofol 5 mg. kg(-1) x h(-1) and 67% N(2)O in oxygen. All patients in both groups received IV isoproterenol at incremental infusion rates (2.5, 5, 7.5, 10, 12.5, 15, and 17.5 ng x kg(-1) x min(-1) for 2 min at each dose) until HR increased more than 20 bpm from baseline values. At the end of each infusion period, hemodynamic data were collected. The HR response to isoproterenol 7.5 ng. kg(-1) x min(-1) was increased more in the propofol group than in the control group (20 +/- 5 versus 14 +/- 4 bpm; P < 0.05). During the isoproterenol infusion at 10 ng. kg(-1) x min(-1), HR increased by more than 20 bpm in all patients in the propofol group but in only 31% of patients in the control group (P < 0.0001). These results suggest that continuous isoproterenol infusion might be useful when a large dose of atropine is ineffective in restoring normal HR during propofol-N(2)O anesthesia. IMPLICATIONS: We demonstrated that the heart rate response to IV isoproterenol infusion is enhanced during propofol-nitrous oxide anesthesia. This suggests that continuous isoproterenol infusion may be useful when a large dose of atropine is ineffective for restoration of normal heart rate in patients receiving propofol-nitrous oxide anesthesia.

Adrenergic beta-Agonists↗

PubMed2003

Choice of electrocardiography lead does not affect the usefulness of the T-wave criterion for detecting intravascular injection of an epinephrine test dose in anesthetized children.

UNLABELLED: Accidental intravascular injection of an epinephrine-containing test dose increases T-wave amplitude of lead II electrocardiogram (EKG) in anesthetized children. We designed this study to test whether the choice of EKG lead would affect the usefulness of simulated intravascular test dose. We studied 32 ASA physical status I infants and children (aged 6-49 mo) undergoing elective surgeries during 1.0 minimum alveolar anesthetic concentration sevoflurane and 67% nitrous oxide in oxygen. When hemodynamic stability was obtained, all subjects received IV saline 0.1 mL/kg, followed 4 min later by an IV test dose (0.1 mL/kg) consisting of 1% lidocaine with 1:200,000 epinephrine (epinephrine 0.5 microg/kg) via a peripheral vein to simulate the intravascular injection of the test dose. Heart rate and systolic blood pressure were recorded every 20 and 60 s, respectively, and leads II (n = 32), V(5) (n = 32) and either lead I (n = 15) or III (n = 17), choosing the one with greater preinjection T-wave amplitude, were continuously recorded for 4 min after the saline and the test dose injections. An IV test dose produced significant increases in heart rate, systolic blood pressure, and T-wave amplitude of all EKG leads studied in all subjects, whereas IV saline elicited no changes in these variables. Maximal increases in T-wave amplitude of leads II, I, III, and V(5) were 158% +/- 69%, 175% +/- 78%, 147% +/- 89%, and 170% +/- 72%, respectively (mean +/- SD, P > 0.05). There was no significant difference in temporal changes in T-wave amplitude among the 4 leads, and sensitivity and specificity were 100% on the basis of the T-wave criterion irrespective of the lead examined. Our results indicate that leads II, I, III, and V(5) of EKG are equally effective for detecting intravascular injection of the epinephrine-containing test dose in sevoflurane-anesthetized children. IMPLICATIONS: To determine whether an epidurally administered local anesthetic has been accidentally injected into a blood vessel, a small dose of epinephrine is often added to a local anesthetic. We found that increases in T-wave amplitude in leads I, II, III, and V(5) of the electrocardiogram are equally sensitive and specific for detecting intravascular injection of the epinephrine-containing test dose in sevoflurane-anesthetized infants and children.

Anesthesia, Epidural↗