Related Experiment Videos
Changes in carbon dioxide tension and oxygen saturation during deep sedation for paediatric cardiac catheterization
1Department of Anesthesiology, Children's Hospital, Denver, Colorado, USA.
Insights
Deep sedation or general anesthesia during pediatric cardiac catheterization can cause hypercarbia (high carbon dioxide) and oxygen desaturation in spontaneously breathing patients. Controlled ventilation prevented these adverse respiratory events.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Medicine
- Respiratory Physiology
Background:
- Cardiac catheterization in infants and children often requires deep sedation or general anesthesia.
- Maintaining adequate oxygenation and ventilation is critical during these procedures, especially in patients with pulmonary hypertension.
Purpose of the Study:
- To investigate the incidence of hypercarbia and oxygen desaturation during deep sedation or general anesthesia in pediatric cardiac catheterization.
- To compare respiratory parameters across different anesthetic regimens, including spontaneous versus controlled ventilation.
Main Methods:
- Observational study of 50 pediatric patients (4 months to 12 years) undergoing cardiac catheterization.
- Prospective data collection on anesthetic regimens (propofol/fentanyl, fentanyl/midazolam, ketamine, or controlled ventilation with pancuronium).
- Monitoring of end-tidal carbon dioxide tension (PetCO2) and SpO2 for 60 minutes.
Main Results:
- Spontaneously ventilated patients (regimens 1, 2, 3) showed significant increases in PetCO2 and decreases in SpO2.
- Controlled ventilation (regimen 4) maintained stable PetCO2 and SpO2 levels.
- Adverse respiratory changes in spontaneously breathing patients may exacerbate pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR).
Conclusions:
- Deep sedation or general anesthesia with spontaneous ventilation in pediatric cardiac catheterization is associated with hypercarbia and hypoxemia.
- Controlled ventilation effectively prevents these respiratory complications.
- Anesthetic management should consider the potential for respiratory compromise in spontaneously breathing pediatric patients undergoing cardiac catheterization.
Abstract:
The purpose of this observational study was to determine whether hypercarbia or oxygen desaturation occurred during our current regimens of deep sedation or general anaesthesia of infants and children undergoing cardiac catheterization. Data were gathered prospectively from 50 consecutive infants and children aged 4 months to 12 years undergoing cardiac catheterization. Several anaesthetists used the following regimens, which were not randomized: 1) propofol. 1.5-2.0 mg.kg-1 and fentanyl 1 microgram.kg-1 IV over 2 min for induction, followed by propofol infusion of 100-150 micrograms.kg-1.min-1; 2) fentanyl 2-3 micrograms.kg-1 and midazolam 0.1-0.2 mg.kg-1 IV over 10-15 min; 3) ketamine 8 mg.kg-1 IM, or 4) same as regimens 1 or 2, plus pancuronium, intubation and controlled ventilation. Regimens 1, 2, and 3 were associated with spontaneous ventilation through the natural airway. End-tidal carbon dioxide tension (PetCO2), SpO2, and respiratory rate were monitored for 60 min. The three regimens employing spontaneous ventilation through the natural airway were associated with both statistically and clinically significant increases in PetCO2 and decreases in SpO2. This raises the possibility that acute exacerbation of PAP and PVR may occur in pulmonary hypertensive patients. In contrast, PetCO2 and SpO2 did not change significantly from baseline in the controlled ventilation group.