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Cardiac arrhythmias in non-intubated children during adenoidectomy. A comparison between enflurane and halothane
Insights
Enflurane anesthesia significantly reduced cardiac arrhythmias in children undergoing adenoidectomy compared to halothane. This suggests enflurane offers a safer anesthetic option for pediatric surgical procedures.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Physiology
Background:
- Cardiac arrhythmias are a concern in pediatric anesthesia.
- Halothane is associated with increased arrhythmia risk.
Purpose of the Study:
- To compare the incidence of cardiac arrhythmias during enflurane and halothane anesthesia in children undergoing adenoidectomy and myringotomy.
- To evaluate the effects of these anesthetics on heart rate, blood pressure, and other physiological parameters.
Main Methods:
- A prospective study involving 167 healthy children aged 1-12 years.
- Monitoring of cardiac arrhythmias, heart rate, blood pressure, capillary perfusion, and end-tidal CO2 tension.
- Comparison between adenoidectomy and myringotomy procedures under enflurane and halothane anesthesia.
Main Results:
- Lower incidence of cardiac arrhythmias during myringotomy versus adenoidectomy.
- Significantly higher arrhythmia incidence with halothane (86.6%) compared to enflurane (38.9%) during adenoidectomy.
- Ventricular arrhythmias were more frequent with halothane (41.3%) than enflurane (2.8%).
- Heart rate increased by ~40% during halothane-induced arrhythmias; heart rate remained stable with enflurane.
Conclusions:
- Enflurane anesthesia is associated with a lower incidence of cardiac arrhythmias, particularly ventricular arrhythmias, in pediatric patients compared to halothane.
- Enflurane may reduce sympathomimetic activity and myocardial susceptibility to catecholamines, contributing to its antiarrhythmic effect.
- Enflurane appears to be a safer anesthetic choice for pediatric adenoidectomy due to its lower risk of cardiac arrhythmias.
Abstract:
The incidence of cardiac arrhythmias, heart rate, blood pressure, capillary perfusion and end-tidal CO2 tension were studied in 167 healthy children 1-12 years of age undergoing adenoidectomy (n = 82) and myringotomy (n = 85) during enflurane and halothane anaesthesia. The incidence of cardiac arrhythmias was significantly lower during myringotomy than during adenoidectomy. In children undergoing adenoidectomy the incidence of arrhythmias was 38.9% during enflurane anaesthesia and 86.6% during halothane anaesthesia (P less than 0.001). In the halothane group ventricular arrhythmias were observed in 19 patients (41.3%) but only in one child (2.8%) in the enflurane group. The ventricular arrhythmias seen during halothane anaesthesia were unifocal in six patients and multifocal in five and classified as ventricular tachycardia in eight children. Heart rate was increased by about 40% at the onset of ventricular arrhythmias. The heart rate remained unchanged with enflurane anaesthesia during surgery, which may reflect a decreased sympathomimetic activity. It is suggested that the low incidence of ventricular arrhythmias during enflurane anaesthesia may be explained by the combination of a reduced sympathomimetic activity and a lowered susceptibility of the myocardium to the actions of endogenous catecholamines.