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Fentanyl intermittent bolus technique for anesthesia in infants and children undergoing cardiac surgery

M C Newland1, P Leuschen, L B Sarafian

  • 1Department of Anesthesiology, University of Nebraska Medical Center, Omaha 68105.

Journal of Cardiothoracic Anesthesia
|August 1, 1989
PubMed

Insights

This study shows that incremental intravenous fentanyl boluses effectively maintain anesthesia and hemodynamic stability in pediatric patients undergoing congenital heart defect surgery. Dosing before cardiopulmonary bypass ensures satisfactory anesthetic depth and stable vital signs throughout the procedure.

Area of Science:

  • Anesthesiology
  • Pediatric Cardiology
  • Pharmacology

Background:

  • Congenital heart defects require complex surgical interventions in pediatric patients.
  • Anesthetic management in these vulnerable patients is critical for surgical success and patient safety.
  • Fentanyl is a commonly used opioid analgesic in pediatric anesthesia.

Purpose of the Study:

  • To evaluate the efficacy and safety of an incremental intravenous fentanyl bolus technique for anesthesia in pediatric patients undergoing corrective surgery for congenital heart defects.
  • To assess hemodynamic stability, anesthetic depth, and plasma fentanyl concentrations during and after surgery.

Main Methods:

  • Eight pediatric patients (4 months to 5 years, ASA III-IV) received fentanyl via incremental IV boluses, reaching a total dose of 100 mcg/kg before cardiopulmonary bypass.
  • Heart rate, systolic blood pressure, anesthetic depth, and plasma fentanyl levels were monitored at various intervals.
  • Radioimmunoassay was used to measure plasma fentanyl concentrations.

Main Results:

  • Heart rate decreased significantly at sternal incision and 30 minutes post-incision.
  • No significant changes in systolic blood pressure or anesthetic depth were observed.
  • Plasma fentanyl levels were 30 +/- 8 ng/mL before cardiopulmonary bypass, falling to 13 +/- 9 ng/mL upon bypass initiation.
  • Fentanyl levels further decreased to 10 +/- 4 ng/mL in the recovery room.

Conclusions:

  • Incremental intravenous fentanyl bolus administration, completed before cardiopulmonary bypass, provides adequate anesthesia and hemodynamic stability in pediatric patients undergoing corrective surgery for congenital heart defects.
  • This dosing strategy ensures satisfactory plasma fentanyl levels and anesthetic depth throughout the surgical procedure.
  • The technique is a safe and effective option for managing anesthesia in this high-risk pediatric population.

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