Karl H W, Swedlow D B, Lee K W, Downes J J
Anesthesiology. 1983 Feb;58(2):142-5. doi: 10.1097/00000542-198302000-00007.
Cutaneous infiltration of dilute solutions of epinephrine for hemostasis during halothane anesthesia can result in ventricular dysrhythmias. Our clinical experience, published reports, and a study comparing piglets with adult swine suggest that children may be less susceptible than adults to dysrhythmias under these conditions. We therefore undertook a prospective survey of heart rate and rhythm in halothane-anesthesized children who received subcutaneous epinephrine for hemostasis. Mass spectrometry was used to quantify end-tidal halothane and to avoid hypercarbia. In 83 children anesthesized with halothane, we continuously recorded ECG, heart rate (HR), end-tidal halothane (ETHalo), and carbon dioxide (ETCO2). The surgeons injected 0.4--15.7 micrograms/kg of epinephrine (in saline or 1% lidocaine) to provide hemostasis at a variety of sites. No child developed a ventricular dysrhythmia. One child had self-limited premature atrial contractions (PAC). Sixty-three children had some increase in heart rate after epinephrine injection, while seven increased their HR 15% or more above pre-injection levels. No relation between any increase in HR and epinephrine dosage, ETHalo, ETCO2, physical status, or age was found by multiple linear regression; however, HR was increased significantly in patients receiving epinephrine in head and neck sites other than the palate. The authors conclude that children tolerate higher doses of subcutaneous epinephrine than adults during halothane anesthesia. The arrhythmogenic dose of epinephrine in children receiving halothane has yet to be determined, but at least 10 micrograms/kg of epinephrine infiltration may be used safely in normocarbic and hypocarbic pediatric patients without congenital heart disease. The presence of PAC and tachycardia emphasize the need for continuous ECG monitoring and caution during halothane anesthesia with epinephrine injection.
在氟烷麻醉期间，为止血而皮内注射稀释的肾上腺素溶液可能会导致室性心律失常。我们的临床经验、已发表的报告以及一项比较仔猪和成年猪的研究表明，在这些情况下儿童可能比成年人对心律失常的易感性更低。因此，我们对在氟烷麻醉下接受皮下注射肾上腺素止血的儿童进行了心率和心律的前瞻性调查。采用质谱法对呼气末氟烷进行定量，以避免高碳酸血症。在83例接受氟烷麻醉的儿童中，我们持续记录心电图、心率（HR）、呼气末氟烷（ETHalo）和二氧化碳（ETCO2）。外科医生注射0.4 - 15.7微克/千克的肾上腺素（溶于生理盐水或1%利多卡因），以便在多个部位进行止血。没有儿童发生室性心律失常。一名儿童出现了自限性房性早搏（PAC）。63名儿童在注射肾上腺素后心率有所增加，而7名儿童的心率比注射前水平升高了15%或更多。多元线性回归未发现心率的任何增加与肾上腺素剂量、ETHalo、ETCO2、身体状况或年龄之间存在关联；然而，在腭部以外的头颈部部位接受肾上腺素的患者心率显著增加。作者得出结论，在氟烷麻醉期间，儿童比成年人能耐受更高剂量的皮下肾上腺素。接受氟烷麻醉的儿童中肾上腺素的致心律失常剂量尚未确定，但至少10微克/千克的肾上腺素浸润可安全用于无先天性心脏病的正常碳酸血症和低碳酸血症儿科患者。PAC和心动过速的出现强调了在氟烷麻醉下注射肾上腺素期间持续进行心电图监测和谨慎操作的必要性。
