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Short-acting barbiturate sedation: effect on arterial pH and PaCO2 in children
A M Lynn1, J P Morray, E B Furman
1Department of Anesthesiology, University of Washington School of Medicine, Children's Hospital & Medical Center, Seattle 98195.
Insights
Thiamylal, a short-acting thiobarbiturate, shows minimal impact on pediatric blood gases (pH and PaCO2) when administered rectally or intravenously. Combining it with fentanyl did not alter these effects in children over two years old.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
Background:
- Thiobarbiturates are commonly used for induction in pediatric anesthesia.
- Understanding their impact on blood gas parameters is crucial for patient safety.
Purpose of the Study:
- To evaluate the effects of thiamylal on arterial blood gases (pH and PaCO2) in pediatric patients.
- To assess the influence of fentanyl when combined with thiamylal.
Main Methods:
- 115 unpremedicated children received thiamylal rectally or intravenously.
- Blood gas analysis (pH, PaCO2) was performed post-administration.
- A subgroup received additional fentanyl for comparison.
Main Results:
- Thiamylal administration resulted in stable arterial pH (7.36) and PaCO2 (40 mmHg).
- Addition of fentanyl did not significantly alter blood gas values.
- Children with cyanotic congenital heart disease showed similar blood gas profiles.
Conclusions:
- Thiamylal has clinically insignificant effects on arterial pH and PaCO2 in pediatric patients.
- Titrated thiobarbiturate administration is safe regarding blood gas homeostasis in children.
Abstract:
One hundred and fifteen unpremedicated children, induced with thiamylal, a short-acting thiobarbiturate, administered rectally (25 mg.kg-1 body wt) or intravenously (6 mg.kg-1) had arterial pH of 7.36 +/- 0.03 and PaCO2 of 40 +/- 4 mmHg. In 22 children over two years of age, the use of fentanyl (1.2 +/- 0.7 microgram.kg-1) in addition to the thiamylal did not change blood gas data compared to those children over two years receiving only barbiturates (pH 7.36 vs 7.36, PaCO2 41 vs 40 mmHg). Children with cyanotic congenital heart disease showed similar pH and PaCO2 to acyanotic children following administration of the short-acting barbiturate. Thiobarbiturates, given in a titrated fashion under direct observation, have clinically small effects on arterial pH and PaCO2 in paediatric patients.