BACKGROUND: The cardiovascular effects of halogenated anesthetic agents in children with normal hearts have been studied, but data in children with cardiac disease are limited. This study compared the effects of halothane, isoflurane, sevoflurane, and fentanyl-midazolam on systemic and pulmonary hemodynamics and myocardial contractility in patients with congenital heart disease. METHODS:Fifty-four patients younger than age 14 scheduled to undergo congenital heart surgery were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl-midazolam. Cardiovascular and echocardiographic data were recorded at baseline and at randomly ordered 1 and 1.5 minimum alveolar concentrations, or predicted equivalent fentanyl-midazolam plasma concentrations. The shortening fraction and ejection fraction (using the modified Simpson rule) were calculated. Cardiac index was assessed by the velocity-time integral method. RESULTS:Halothane caused a significant decrease in mean arterial pressure, ejection fraction, and cardiac index, preserving only heart rate at baseline levels. Fentanyl-midazolam in combination caused a significant decrease in cardiac index secondary to a decrease in heart rate; contractility was maintained. Sevoflurane maintained cardiac index and heart rate and had less profound hypotensive and negative inotropic effects than halothane. Isoflurane preserved both cardiac index and ejection fraction, had less suppression of mean arterial pressure than halothane, and increased heart rate. CONCLUSIONS:Isoflurane and sevoflurane preserved cardiac index, and isoflurane and fentanyl-midazolam preserved myocardial contractility at baseline levels in this group of patients with congenital heart disease. Halothane depressed cardiac index and myocardial contractility.
RCT Entities:
BACKGROUND: The cardiovascular effects of halogenated anesthetic agents in children with normal hearts have been studied, but data in children with cardiac disease are limited. This study compared the effects of halothane, isoflurane, sevoflurane, and fentanyl-midazolam on systemic and pulmonary hemodynamics and myocardial contractility in patients with congenital heart disease. METHODS: Fifty-four patients younger than age 14 scheduled to undergo congenital heart surgery were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl-midazolam. Cardiovascular and echocardiographic data were recorded at baseline and at randomly ordered 1 and 1.5 minimum alveolar concentrations, or predicted equivalent fentanyl-midazolam plasma concentrations. The shortening fraction and ejection fraction (using the modified Simpson rule) were calculated. Cardiac index was assessed by the velocity-time integral method. RESULTS:Halothane caused a significant decrease in mean arterial pressure, ejection fraction, and cardiac index, preserving only heart rate at baseline levels. Fentanyl-midazolam in combination caused a significant decrease in cardiac index secondary to a decrease in heart rate; contractility was maintained. Sevoflurane maintained cardiac index and heart rate and had less profound hypotensive and negative inotropic effects than halothane. Isoflurane preserved both cardiac index and ejection fraction, had less suppression of mean arterial pressure than halothane, and increased heart rate. CONCLUSIONS:Isoflurane and sevoflurane preserved cardiac index, and isoflurane and fentanyl-midazolam preserved myocardial contractility at baseline levels in this group of patients with congenital heart disease. Halothanedepressed cardiac index and myocardial contractility.
Authors: Marlos Gonçalves Sousa; Roberta Carareto; Andrigo Barboza De-Nardi; Fábio L C Brito; Newton Nunes; Aparecido Antonio Camacho Journal: Can Vet J Date: 2007-03 Impact factor: 1.008
Authors: Bradley D Allen; Pim van Ooij; Alex J Barker; Maria Carr; Maya Gabbour; Susanne Schnell; Kelly B Jarvis; James C Carr; Michael Markl; Cynthia Rigsby; Joshua D Robinson Journal: J Magn Reson Imaging Date: 2015-01-22 Impact factor: 4.813
Authors: Justin J Elhoff; Shahryar M Chowdhury; Carolyn L Taylor; Marc Hassid; Andrew J Savage; Andrew M Atz; Ryan J Butts Journal: Pediatr Transplant Date: 2016-10-30
Authors: Rashmi S Rajendra; Alan G Brady; Virginia L Parks; Clara V Massey; Susan V Gibson; Christian R Abee Journal: J Med Primatol Date: 2010-02-08 Impact factor: 0.667
Authors: Jyrson Guilherme Klamt; Walter Villela de Andrade Vicente; Luis Vicente Garcia; Cesar Augusto Ferreira Journal: Anesthesiol Res Pract Date: 2010-08-19