ELECTROCARDIOGRAPHIC AND HEMODYNAMIC-CHANGES ASSOCIATED WITH UNINTENTIONAL INTRAVASCULAR INJECTION OF BUPIVACAINE WITH EPINEPHRINE IN INFANTS

SINGLE-DOSE caudal administration of bupivacaine has been accepted wid ely as a means of providing perioperative analgesia for lower limb, an operineal, and lower abdominal procedures in children.1,2 Unintentiona l intravascular injection of local anesthetic during caudal block plac ement may cause life-threatening central nervous system and cardiac se quelae. A test dose of 10-15 mug epinephrine has been advocated as a r eliable indicator of intravascular injection in adults,3,4 but epineph rine has not been proved reliable as an indicator of intravascular inj ection in anesthetized infants and children.5 In conscious infants hav ing a caudal anesthetic, the reliability of epinephrine as an indicato r of intravascular injection has not been studied. We report five case s in which ST-T-wave changes and relative bradycardia during administr ation of a test dose alerted us to intravascular injection during caud al administration of bupivacaine with epinephrine.