{
  "abstract": "Background and Aims A young female patient scheduled for bilateral lung metastatectomy underwent a T7–8 epidural catheterization in the left decubitus position. 10 minutes after injection of a test dose of 3 cc 1.5% plain lignocaine with 5 ug/cc adrenaline, she complained of heaviness in the right upper limb. She denied having any sensorimotor symptoms elsewhere and had minimal changes in the pulse rate and blood pressure. Examination revealed sensory deficit in right C7-T8 and left T3-T6 dermatomes and grade 3/5 power in the right hand and forearm muscles. The pattern and distribution of the sensorimotor deficits pointed to intrathecal injection with localization of action to the nondependent side. Isobaric intrathecal solutions are known to behave as hypobaric solutions in the CSF and therefore distribute in an antigravity manner. While total spinal block and severe haemodynamic compromise is well described, our patient had lateralization of effects and minimal haemodynamic changes, probably due to the lateral decubitus position given during the procedure. The patient had an uneventful surgery (under general anaesthesia) and postoperative recovery. The catheter was removed at the end of surgery.Conclusions Discussion The test dose described above has been questioned in literature as it has been extrapolated from the lumbar epidural test dose. It has been considered excessive in the thoracic segments due to its potential to cause severe harm negating its role as a ‘test dose’. It was fortunate that our patient had a largely unilateral spinal block rather than a high bilateral block. Also the patient’s alertness in reporting mild symptoms was crucial. In conclusion, the case emphasizes the need to meticulously check for effects of the test dose as well as for anaesthesiologistss to consider a smaller test dose for a thoracic epidural.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India"
      ],
      "name": "Madhavi Shetmahajan"
    }
  ],
  "title": "P004 Thoracic epidural test dose – unusual presentation and a narrow escape",
  "uid": "89236f13-b903-5917-8fcb-0380696d0bb8"
}