Abstract
Background: Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old. Methods: We conducted a monocentric, retrospective study of all catheterization procedures (2008–2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables. Results: 803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 (p = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) (p < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients (p = 0.05), smaller weights (p < 0.01), palliated status (OR 3.2 [1.2–8.9], p = 0.02), two-ventricle physiology (OR 7.3 [2.7–20.2], p < 0.01), cyanosis (OR 4.6 [2.2–9.8], p < 0.01), pulmonary hypertension (OR 5.6 [2.0–15.5], p < 0.01), interventional catheterization (OR 1.8 [1.1–3.2], p = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8–455.1], p = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2–12.0], p < 0.01). Conclusion: Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.
Highlights
Children with congenital heart disease require repeated catheterization procedures to assess disease progression and therapeutic options [1]
We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children
In the multivariable model, palliated status, twoventricle physiology, cyanosis, pulmonary hypertension (PAH), interventional catheterization and procedure-type risk category 4 were independent predictors of high-severity adverse events
Summary
Children with congenital heart disease require repeated catheterization procedures to assess disease progression and therapeutic options [1]. Anesthetic management in the catheterization laboratory is an integral part of the process and significantly impacts the quality of the procedure, patient safety and comfort [2]. Both sedation and general anesthesia (GA) are frequently used but directly influence cardiopulmonary physiology [3]. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children
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