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Sedation versus General Anesthesia for Cardiac Catheterization in Infants: A Retrospective, Monocentric, Cohort
Marian Mikus1, Thomas Welchowski2, Ehrenfried Schindler1
1Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Insights
Sedation is a safe and effective anesthetic for cardiac catheterization in infants, reducing adverse events and the need for hemodynamic support compared to general anesthesia (GA). This finding is crucial for managing pediatric congenital heart disease patients.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Congenital Heart Disease Management
Background:
- Infants with congenital heart disease (CHD) often require repeated cardiac catheterization procedures.
- Anesthetic management choices can impact procedural outcomes, yet specific recommendations for infants are limited.
- This study investigated the safety and efficacy of sedation versus general anesthesia (GA) in young children undergoing cardiac catheterization.
Purpose of the Study:
- To compare the rates of high-severity adverse events (HSAE) between sedation and GA in children under two years old undergoing cardiac catheterization.
- To identify risk factors associated with adverse events in this pediatric population.
- To evaluate the impact of anesthetic choice on the need for hemodynamic support and hospital stay.
Main Methods:
- A retrospective, monocentric study analyzed cardiac catheterization procedures performed between 2008 and 2013.
- Propensity-score-adjusted models were used to compare HSAE rates, considering pre- and intra-procedural variables.
- Patient demographics, procedural details, and outcomes including HSAE, conversion rates, and hospital stay were recorded.
Main Results:
- The study included 803 procedures in 619 patients (mean age 6.9 months), with 46% under GA and 54% under sedation.
- Sedation was associated with significantly lower HSAE rates (9% vs. 20% for GA, p < 0.01) and a shorter hospital stay (4.1 vs. 4.9 days, p = 0.01).
- Risk factors for adverse events included older age, lower weight, palliated status, two-ventricle physiology, cyanosis, pulmonary hypertension, and interventional procedures. Sedation decreased the need for hemodynamic support (OR 5.2, p < 0.01).
Conclusions:
- Sedation is a safe and effective alternative to GA for cardiac catheterization in children under two years old, demonstrating lower HSAE rates.
- Sedation also reduces the requirement for hemodynamic support during these procedures.
- Unexpected risk factors, such as older age and two-ventricle physiology, were identified in this specific pediatric age group.
Background:
Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old.
Methods:
We conducted a monocentric, retrospective study of all catheterization procedures (2008-2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables.
Results:
803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 (p = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) (p < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients (p = 0.05), smaller weights (p < 0.01), palliated status (OR 3.2 [1.2-8.9], p = 0.02), two-ventricle physiology (OR 7.3 [2.7-20.2], p < 0.01), cyanosis (OR 4.6 [2.2-9.8], p < 0.01), pulmonary hypertension (OR 5.6 [2.0-15.5], p < 0.01), interventional catheterization (OR 1.8 [1.1-3.2], p = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8-455.1], p = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2-12.0], p < 0.01).
Conclusion:
Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.
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