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Hemodynamic effects of ketamine in children undergoing cardiac catheterization
W Berman1, R R Fripp, M Rubler
1Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque.
Insights
Ketamine use during cardiac catheterization increases oxygen consumption and cardiac output in children. Caution is advised as ketamine can affect circulatory dynamics and complicate data interpretation.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Cardiovascular Physiology
Background:
- Ketamine is utilized for sedation in pediatric cardiac catheterization.
- Understanding ketamine's hemodynamic effects is crucial for patient management and data accuracy.
Purpose of the Study:
- To investigate ketamine-induced circulatory changes in pediatric patients undergoing cardiac catheterization.
- To assess the impact of ketamine on pulmonary and systemic vascular resistance, oxygen consumption, and cardiac output.
Main Methods:
- Prospective study involving 28 acyanotic children (aged 4-161 months) undergoing cardiac catheterization.
- Continuous measurement of oxygen consumption (VO2).
- Monitoring of pulmonary to systemic flow ratio, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), heart rate, cardiac output, and pulmonary arterial pressure (PAP).
Main Results:
- Ketamine administration led to increased VO2, heart rate, cardiac output, and PAP in all patients.
- The pulmonary to systemic flow ratio decreased slightly in patients with left-to-right shunts (p < 0.05).
- The ratio of PVR to SVR significantly increased (p < 0.001), with greater changes observed in patients with elevated resting PVR.
Conclusions:
- Ketamine significantly alters circulatory parameters in children during cardiac catheterization.
- Increased PAP and altered vascular resistance warrant careful consideration.
- Ketamine's effects can complicate the interpretation of cardiac catheterization data, particularly if VO2 is not directly measured.
Abstract:
Ketamine is used to supplement sedation during cardiac catheterization. We studied ketamine-induced circulatory changes in 28 acyanotic children (18 of whom had left-to-right shunts), aged 4-161 months (mean, 33 months). Oxygen consumption (VO2) was measured continuously. In the 18 patients with shunts, the pulmonary to systemic flow ratio fell slightly (2.3 +/- 1.1 to 1.8 +/- 0.4, p less than 0.05). In all patients, the ratio of pulmonary (PVR) to systemic vascular resistance (SVR) rose from 0.16 +/- 0.09 to 0.28 +/- 0.21, p less than 0.001. Ketamine increases VO2, heart rate, cardiac output, and pulmonary arterial pressure (PAP). The rise in PAP is more consistent than the rise in PVR; resistance changes were greatest in patients with elevated resting PVR (r = 0.54). Caution should be used in administering ketamine to selected subjects; moreover, ketamine can confuse interpretation of cardiac catheterization data, especially if VO2 is assumed and not measured.