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Real-Time Systemic Hemodynamic Monitoring in Children with Congenital Heart Disease: Comparison of Two Anesthetic Induction Protocols

Ding Han, Ya-Guang Liu, Yi Luo, Jia Li MD and Chuan Ou-Yang

Objective: Inhaled sevoflurane and intravascular ketamine are commonly used for congenital heart defect (CHD) children undergoing cardiac surgery. We used a new and direct systemic hemodynamic monitoring technique pressure recording analytical method (PRAM) to compare the effects of sevoflurane-midazolam-sufentanil and ketamine-midazolam-sufentanil during anesthesia induction.

Methods: Forty-three children with ventricular septal defect (2.2 ± 1.2 years) were randomized to receive sevoflurane (Group S) or ketamine (Group K) for basal anesthesia, followed by combined intravenous anesthetics and intubation. Hemodynamic data recorded by PRAM included heart rate (HR), systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) after basal anesthesia, 1, 2, 5 min after combined intravenous anesthetics, 1, 2, 5 and 10 min after tracheal intubation. Rate-pressure product (RPP) and cardiac power output (CPO) were calculated.

Results: HR, SBP, DBP and MBP showed a significant decrease during induction (p<0.001 for all), then a small and significant increase at intubation (p<0.0001 for all), followed by a gradual decrease (p<0.0001 for all). As compared to group S, group K had faster decreases during induction in arterial pressures (p<0.01 for all), higher HR, arterial pressures, SVRI, dp/dtmax, RPP, lower SVI, CI, CPO (p<0.05 for all) during the study period.

Conclusion: Sevoflurane, as compared to ketamine, resulted in stable and favorable effects on systemic hemodynamics and myocardial energetic in children with ventricular septal defect.