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Ketamine-etomidate for children undergoing cardiac catheterization.

Madhur Malik1, Vishwas Malik, Sandeep Chauhan

  • 1Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India. madhurmed80@rediffmail.com

Asian Cardiovascular & Thoracic Annals
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Summary

Low-dose ketamine and etomidate anesthesia did not alter hemodynamics in pediatric patients with right-to-left shunts. However, left-to-right shunts showed significant hemodynamic changes, requiring further study for anesthetic titration in congenital heart disease.

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Area of Science:

  • Pediatric Cardiology
  • Anesthesiology
  • Cardiovascular Physiology

Background:

  • Congenital heart disease (CHD) with shunts significantly impacts cardiovascular hemodynamics.
  • Anesthetic management in pediatric cardiac catheterization requires careful consideration of hemodynamic stability.
  • Combined ketamine and etomidate is a potential anesthetic option, but its specific effects on different shunt types are not fully understood.

Purpose of the Study:

  • To evaluate the hemodynamic effects of a combined low-dose ketamine and etomidate anesthetic regimen.
  • To compare these effects in pediatric patients with right-to-left shunts versus left-to-right shunts during cardiac catheterization.

Main Methods:

  • A prospective study involving 60 pediatric patients undergoing cardiac catheterization.
  • Patients were divided into two groups: 30 with right-to-left shunts and 30 with left-to-right shunts.
  • Both groups received a single dose of etomidate (0.3 mg·kg⁻¹) and ketamine (1 mg·kg⁻¹). Hemodynamic parameters were monitored.

Main Results:

  • No significant hemodynamic alterations were observed in patients with right-to-left shunts.
  • Patients with left-to-right shunts exhibited significant changes in heart rate, pressures (right atrial, mean arterial, mean pulmonary artery, pulmonary artery wedge), and systemic vascular resistance index.
  • A decrease in pulmonary blood flow and the pulmonary-systemic shunt ratio was noted in the left-to-right shunt group.

Conclusions:

  • Combined low-dose ketamine and etomidate appears hemodynamically stable for pediatric patients with right-to-left shunts during cardiac catheterization.
  • This anesthetic combination induces significant hemodynamic changes in pediatric patients with left-to-right shunts.
  • Further research involving dose titration of this anesthetic combination is warranted for patients with left-to-right shunts and CHD.