Abstract
Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.
Highlights
Children with congenital heart disease (CHD) undergoing cardiac surgery are in a precarious hemodynamic state and the choice of the anesthetic induction agent seems important in such a situation
There exist a few studies in the literature on the hemodynamic effects of anesthetic induction agents in children with CHD [1]-[10]
Based on the anesthetic induction agent to be used, the patients were divided into three groups of 20 each using computer generated random number table: group E, group K and group S
Summary
Children with congenital heart disease (CHD) undergoing cardiac surgery are in a precarious hemodynamic state and the choice of the anesthetic induction agent seems important in such a situation. The doses of anesthetic agents otherwise tolerated by patients with normal cardiovascular anatomy might lead to hemodynamic collapse in children with CHD. No specific anesthetic induction technique has been advocated for children with CHD. A number of factors influence the choice of the anesthetic technique including heart rate (HR), rhythm, myocardial contractility, shunting, outflow tract obstruction, ventricular dilation and hypertrophy, and pulmonary hypertension in the pediatric cardiac surgical patient. The anesthetic goals remain to maintain normal HR, sinus rhythm, maintain myocardial contractility, minimize pulmonary or systemic overcirculation across shunt lesion and lower pulmonary vascular resistance (PVR)
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