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Published on: August 1, 2018
Relationship between anaesthesia strategy and intracardiac hemodynamics during paediatric cardiac catheterisation
Andrew H Smith1,2, Steven J Healan3, Genevieve E Staudt4
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Insights
Anesthetic choice significantly impacts hemodynamics in children with heart disease during cardiac catheterization. Moderate sedation increased pulmonary/systemic blood flow ratio, while total intravenous anesthesia affected systemic vascular resistance.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Cardiovascular Physiology
Background:
- Children with heart disease require careful hemodynamic management during cardiac catheterization.
- The choice of anesthesia can influence cardiovascular parameters, potentially affecting procedural outcomes.
- Understanding these effects is crucial for optimizing patient care in this vulnerable population.
Purpose of the Study:
- To investigate the hemodynamic implications of different anesthetic choices in pediatric patients with heart disease undergoing cardiac catheterization.
- To compare the effects of moderate sedation versus general anesthesia on key hemodynamic variables.
- To analyze the impact of inhaled volatile anesthesia versus total intravenous anesthesia on hemodynamics in specific pediatric cardiac procedures.
Main Methods:
- Study 1: Secondary analysis of hemodynamic data from infants with hypoplastic left heart syndrome undergoing catheterization, comparing moderate sedation and general anesthesia.
- Study 2: Prospective analysis of patients undergoing procedures for patent ductus arteriosus closure or heart transplant biopsy, comparing inhaled volatile anesthesia and total intravenous anesthesia.
- Hemodynamic parameters analyzed included pulmonary and systemic vascular resistance indexed to body surface area (PVRi, SVRi) and pulmonary/systemic blood flow (Qp/Qs).
Main Results:
- In Study 1, moderate sedation was associated with a >2-fold increased odds of Qp/Qs >1, irrespective of shunt type, PVRi, or patient size.
- In Study 2, total intravenous anesthesia resulted in significantly higher SVRi compared to inhaled volatile anesthesia.
- In Study 2 subgroups, Qp/Qs increased with total intravenous anesthesia (PDA closure), and left ventricular end-diastolic pressure rose with total intravenous anesthesia (heart transplant).
Conclusions:
- Anesthetic type significantly influences hemodynamic parameters such as SVRi, left ventricular end-diastolic pressure, and Qp/Qs during cardiac catheterization in children.
- Clinical decisions based on hemodynamic data in these patients should consider the chosen anesthetic agent and its intraprocedural management.
- Careful selection and management of anesthesia are critical for accurate hemodynamic assessment and patient safety in pediatric cardiac catheterization.
Objectives:
Describe the hemodynamic implications of anaesthetic choice among children with heart disease undergoing cardiac catheterisation.
Methods:
Study 1 was a secondary analysis of data obtained during catheterisation-based hemodynamic assessment of infants with hypoplastic left heart syndrome following Stage 1 palliation, randomised in the Single Ventricle Reconstruction trial. Measured and calculated hemodynamics including pulmonary and systemic vascular resistance indexed to body surface area (PVRi and SVRi respectively) and pulmonary/systemic blood flow (Qp/Qs) were analysed with respect to anaesthetic employed during catheterisation, classified as moderate sedation or general anaesthesia. Study 2 consisted of a single centre, prospective analysis of patients requiring percutaneous closure of a patent ductus arteriosus or endomyocardial biopsy after orthotopic heart transplant. Participants underwent hemodynamic assessment first using inhaled volatile anaesthesia (IA), and then transitioned to total intravenous anaesthesia, comparing hemodynamic measures with respect to anaesthetic approach.
Results:
In Study 1, independent of shunt type, PVRi, and patient size, moderate sedation was associated with a greater than two-fold odds of a Qp/Qs >1 (OR 2.12, 95%CI 1.18-3.87, p = 0.013). In Study 2, while PVRi was similar, SVRi was significantly higher using total intravenous anaesthesia. Among the patent ductus arteriosus subgroup, Qp/Qs increased significantly with a total intravenous anaesthesia relative to IA (p = 0.003); additionally, among the orthotopic heart transplant subgroup, left ventricular end diastolic pressure increased following a transition to total intravenous anaesthesia (p = 0.002).
Conclusions:
Analyses of hemodynamics during catheterisation support a significant impact of anaesthetic type on hemodynamic values including SVRi, left ventricular end diastolic pressure, and Qp/Qs. Anaesthesia choice and intraprocedural management of SVRi are important considerations when making clinical decisions based on hemodynamic data.
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