To the Editor:--The case report by Fitzgibbon et al. presents an unfortunate result of standard anesthesia practice. The use of epinephrine in the test dose of the newly placed epidural catheter was, in my opinion, poor choice. Epinephrine is clearly contraindicated in local anesthetics administered near terminal arteries as in the digits or the penis. As the authors point out, the resection of both thoracic and lumbar aneurysms puts the spinal cord at high risk for ischemic insult. They list individual factors associated with neurologic deficits, including the administration of epinephrine in the anesthetic solution, but fail to make a connection of multiple factors in their conclusion. The "volume/pressure effect" of the epidural drugs is unavoidable. The use of epinephrine, however, is not essential. In this instance, I believe the administration of epinephrine as part of the test doses could have added to the ischemia of the cord.
Bernard L. Waltuck, M.D., The Good Samaritan Medical Center, 1300 North Flagler Drive, West Palm Beach, Florida 33401.