Administración del clorhidrato de S(+)-ketamina para la dosis test epidural. Comparación con lidocaina y adrenalina.
ABSTRACT Test dose during epidural anesthesia is essential to avoid intravenous or subarachnoid injection of local anesthetics. There is no agreement on the drug or dose used. Hypothesis: S(+)-ketamine could be useful to detect epidural catheter malposition. We do a two phase study to evaluate the iv (IVPh) and the SA (SAPh) effect of S(+)-ketamine, simulating accidental administration. Material and methods. Ethics committee permission and written informed consent were obtained. Double blinded aleatorized studies. IVPh: Eighty patients, ASA I, aged 18-65 divided into four groups of 20. Simulating an accidental iv administration, 3ml injection of: S+K group, S(+)-ketamine 0.5 mg.kg-1; L5% group, lidocaine 1.5mg.kg-1; ADR, adrenaline 15?g; SF group, physiologic saline. Control for SAP, MAP, DAP, HR, SpO2, and clinical effects at 0, 2, 5, 8, 10, and 15 min after drug injection. SAPh: Fifty-seven patients, ASA I, aged 18-65 divided into three groups of 19. Simulating an accidental SA administration, 3 ml injection of: S+K group, S(+)-ketamine 0.5 mg.kg-1; L5% group, lidocaine 1.5 mg.kg-1; SF group, physiologic saline. Control for SAP, MAP, DAP, HR, SpO2, motor block, sensory block level, and clinical effects at 0, 2, 5, 8, 10, and 15 min after drug injection. Statistics: Chi-square, ANOVA, t-test, sensibility, specificity, predictive positive and negative values were obtained. Significance p<0.05. Results. IVPh: increase in SAP, MAP, DAP and HR (p<0.05) was observed at 2, 5, 8 and 10 min compared to basal in the S+K group only. In this group we chose SAP 5 min increase, showing sensibility 100%, specificity 92%, PPV 93%, NPV 100%. Clinical effects were more frequent in the S+K group (p<0.05) and appeared < 5 min. SAPh: significant decrease in SAP at 2, 5, 8,10 and 15 min was observed in the L5% and S+K groups. Sensory and motor block appeared in the S+K and L5% groups (p<0.05). Clinical effects appeared >10 min after SA injection in the S+K group. Conclussions. During epidural anesthesia S+K 0.5 mg.kg 1 could be a useful marker of both accidental iv (increase of 15 mmHg in SAP at 5 min) or SA (sensory and motor block at 2 min) injection.
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Advisor:Errando Oyonate, Carlos Luis; Palanca Sanfrancisco, Jose Mª
School:Universitat de València
Source Type:Master's Thesis
Date of Publication:04/29/2008