Sensibilidad de la dosis de prueba epidural para detectar inyección intravascular: meta-análisis
La presente revisión sistemática surge como estrategia para resumir la evidencia disponible en torno a la realización de la dosis de prueba y su validez evaluando la sensibilidad, como método para detectar la inyección intravascular epidural inadvertida.
Epidural test dose is a procedure that allows detecting inadvertent intravascular injection. The aim of this study is to systematically review and summarize available evidence regarding the performance of test dose and its value as a method for detecting inadvertent epidural intravascular injection. METHODS: Two reviewers independently extracted relevant data from studies that met inclusion criteria. The published data of the validity of the test were presented and the sensitivity was scored and summarized as well as the maximum adrenergic response and the time in which this one is reached. In order to evaluate associations between measures of interest and variables such as type of measurement, mean age, type of induction and halogen a multilevel meta-regression model was fitted. RESULTS: From 758 studies, 21 randomized double-blind clinical trials were selected, in which 15 μg epinephrine versus placebo or lidocaine without epinephrine were administered intravenously. A sensitivity of 99.8% (95% CI 97.4-100%) was found for the T wave voltage decrease ≥25%, 99.2% (95% CI 97.5-100%) for the systolic blood pressure (increase ≥ 15 mmHg), 96,1% (95% CI 93.2-98 , 3%) for the modified heart rate criterion (increase ≥ 10 bpm) and 84.6% (95% CI 79, 5-89.1%) for the standard heart rate criterion (increase ≥20 bpm). The specifity was a 100% in most cases. DISCUSSION: The epidural test dose reaches a global mayor sensitivity of 84%, although it may be affected by age, anesthesia characteristics and type of measurement. Inter-study differences, risk of bias, and publication bias require caution in taking these results.