Pulmonary-to-Systemic Blood Flow Ratio Effects of Sevoflurane, Isoflurane, Halothane, and Fentanyl/Midazolam with 100% Oxygen in Children with Congenital Heart Disease

Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin, Houston, TX 77030-2399, USA.
Anesthesia & Analgesia (Impact Factor: 3.47). 12/2002; 95(5):1200-6, table of contents. DOI: 10.1097/00000539-200211000-00016
Source: PubMed


The cardiovascular effects of volatile anesthetics in children with congenital heart disease have been studied, but there are limited data on the effects of anesthetics on pulmonary-to-systemic blood flow ratio (Qp:Qs) in patients with intracardiac shunting. In this study, we compared the effects of halothane, isoflurane, sevoflurane, and fentanyl/midazolam on Qp:Qs and myocardial contractility in patients with atrial (ASD) or ventricular (VSD) septal defects. Forty patients younger than 14 yr old scheduled to undergo repair of ASD or VSD were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl/midazolam. Cardiovascular and echocardiographic data were recorded at baseline, randomly ordered 1 and 1.5 mean alveolar anesthetic concentration (MAC) levels, or predicted equivalent fentanyl/midazolam plasma levels. Ejection fraction (using the modified Simpson's rule) was calculated. Systemic (Qs) and pulmonary (Qp) blood flow was echocardiographically assessed by the velocity-time integral method. Qp:Qs was not significantly affected by any of the four regimens at either anesthetic level. Left ventricular systolic function was mildly depressed by isoflurane and sevoflurane at 1.5 MAC and depressed by halothane at 1 and 1.5 MAC. Sevoflurane, halothane, isoflurane, or fentanyl/midazolam in 1 or 1.5 MAC concentrations or their equivalent do not change Qp:Qs in patients with isolated ASD or VSD. IMPLICATIONS: Sevoflurane, halothane, isoflurane, and fentanyl/midazolam do not change pulmonary-to-systemic blood flow ratio in children with atrial and ventricular septal defects when administered at standard anesthetic doses with 100% oxygen.

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Available from: Shannon Marie Rivenes, Mar 02, 2014
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    • "Tachycardia and increased myocardial contractility can cause this and must be given thorough consideration. It responds to volume, increase in SVR with alpha agonists such as Phenylephrine or Ephedrine.[12]Pain management is a critical factor during intra and postoperative management. "

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    • "Each of these methods will raise PVR and reduce SpO2. These patients may be required to a SpO2 ranges from 70% to 80% for finest systemic perfusion.[57585960] "
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