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Hemodynamic responses to etomidate in pediatric patients with congenital cardiac shunt lesions
Naresh Dhawan1, Sandeep Chauhan, Shyam Sunder Kothari
1Department of Cardiac Anesthesiology, Cardio Thoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. naresh_d59@rediffmail.com
Insights
Intravenous etomidate at 0.3 mg/kg showed minimal hemodynamic changes in children with congenital heart shunts. These findings suggest etomidate is safe for this patient population, with no clinically significant effects on shunt fraction.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Congenital heart shunts are common in pediatric patients.
- Hemodynamic stability is crucial during procedures in these children.
- Etomidate is an anesthetic agent with a generally favorable hemodynamic profile.
Purpose of the Study:
- To investigate the effects of intravenous etomidate on hemodynamic parameters in children with congenital cardiac shunts.
- To assess changes in shunt fraction following etomidate administration.
- To determine the safety and efficacy of etomidate in this specific pediatric population.
Main Methods:
- Prospective observational study conducted in a tertiary referral cardiac center.
- Thirty children with congenital cardiac shunts were divided into two groups: right-to-left shunts (n=15) and left-to-right shunts (n=15).
- Hemodynamic parameters (SMAP, MPAP, RAP, PAWP) and shunt fraction (Qp/Qs) were measured at baseline and after a single dose of etomidate (0.3 mg/kg).
Main Results:
- In children with right-to-left shunts, etomidate caused a statistically, but not clinically, significant increase in systemic arterial saturation.
- In children with left-to-right shunts, etomidate led to statistically, but not clinically, significant decreases in right atrial pressure and systemic and pulmonary artery saturation.
- No significant changes were observed in heart rate, systemic mean arterial pressure, pulmonary artery pressures, or vascular resistance indices in either group.
Conclusions:
- Etomidate at a dose of 0.3 mg/kg results in minimal hemodynamic alterations in children with congenital cardiac shunts.
- The observed changes in hemodynamic parameters and shunt fraction are not considered clinically significant.
- Etomidate appears to be a safe anesthetic option for pediatric patients with congenital heart disease and shunts.
Objective:
The authors investigated the effects of intravenous etomidate on hemodynamics in children with congenital cardiac shunts.
Design:
Prospective observational study.
Setting:
Catheterization laboratory in tertiary referral cardiac center.
Participants:
Thirty children with congenital cardiac shunt lesions.
Interventions:
Fifteen children having congenital right to left shunts (group A) and 15 children with left to right shunts (group B) were studied. Systemic mean arterial pressure (SMAP), mean pulmonary artery pressures (MPAP), right atrial pressures (RAP), and pulmonary artery wedge pressure (PAWP) were recorded. Systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), and pulmonary-to-systemic blood flow ratio (Qp/Qs) were calculated on room air at baseline and following a single dose of 0.3 mg/kg of etomidate.
Measurements And Main Results:
Heart rate (HR), SMAP, RAP, systemic blood flow (Qs), Qp/Qs, and SVRI did not show any significant change; whereas systemic arterial saturation increased from 77.3% to 79.3%, which was statistically but not clinically significant in the authors' opinion following etomidate in group A. No significant differences in HR, SMAP, MPAP, PAWP, PVRI, SVRI, Qs, pulmonary blood flow (Qp), and Qp/Qs ratio were seen; whereas RAP, systemic, and pulmonary artery saturation decreased in group B after etomidate. Although statistically significant, the decreases were not clinically significant.
Conclusion:
Etomidate at 0.3 mg/kg produces very minimal changes in hemodynamic parameters and shunt fraction in children with congenital shunt lesions.
