Influence of total inhalation anesthesia with sevoflurane on hemodynamic in children with congenital heart disease
He Chen
Han Ding
Liu Yaguang
Jia Qingyan
Ma Jun
Li Jia
Ouyang Chuan
Abstract：Objective To explore the influence of total inhalation anesthesia with sevoflurane on hemodynamic in children with congenital heart disease.Methods Thirty-two children with ventricular septal defect who underwent complete repair surgery from October 2013 to November 2014 were randomly divided into sufentanilmidazolam group (SM group,16 cases) given sevoflurane inhalation as basic anesthesia followed by intravenous administration of pipecuronium (0.2 mg/kg),midazolam (0.2 mg/kg),sufentanil (1 μg/kg),and sevoflurane group (S group,16 cases) given sevoflurane inhalation as basal anesthesia followed by sevoflurane inhalation with dose of 2.0 MAC and intravenous administration of pipecuronium (0.2 mg/kg).Intubation was performed 5 mins after induction.Hemodynamic data were recorded,including heart rate (HR),systolic pressure,diastolic pressure,stroke volume index (SVI),cardiac index (CI),systemic vascular resistance index (SVRI),the maximal slope of systolic upstroke (dp/dt) after basal anesthesia (T0),1,2,5 min after induction (T1,T2,T3),1,2,5 and 10 min after intubation (T4,T5,T6,T7,respectively).The rate pressure product (RPP) was calculated.Results At T0,hemodynamic indices had no significant differences between the two groups (P ＞0.05).At T1,T2,T3,HR and RPP were significantly reduced,and SVI was significantly increased compared with those at T0 in SM group [(114±12),(110±12),(102±14) times/min vs (123 ±17) times/min,(10.5±1.5),(9.9±1.2),(9.2±1.5) vs (11.6±2.2),(29±9),(30±10),(31±11) ml/m2vs (26±7) ml/m2];HR and RPP were significantly increased,and SVI was significantly reduced compared with those at T0 in S group[(125 ±19),(131 ±20),(135±14) times/min vs (119±16) times/min,(11.6±2.3),(12.0±2.4),(12.4±2.2) vs (11.2 ±1.9),(25 ±7),(24 ±7),(22 ±6) ml/m2 vs (27 ±7) ml/m2];at T1,T2,T3,HR and RPP were higher,and SVI was lower in S group than those in SM group (all P ＜ 0.05).At T3,T4,T5,T6,T7,HR,systolic pressure,diastolic pressure,dp/dt and RPP increased and then decreased in SM group;the dp/dt,RPP,systolic blood pressure increased and then decreased in S group;HR,RPP,SVRI in S group were significantly higher than those in SM group [T3 point:(135 ± 14) times/min vs (102 ± 14) times/min,(12.4±2.2) vs (9.2 ±1.5),(1 561 ±317) dyne · s · m2/cm5 vs (1 436 ±313) dyne · s · m2/cm5;T4point:(140± 14) times/min vs (109 ± 13) times/min,(13.5 ±2.9) vs (11.0±2.0),(1 649 ±270) dyne · s · m2/cm5 vs (1 415 ±270) dyne · s · m2/cm5;T5 point:(138 ± 14) times/min vs (106 ±12) times/min,(12.9 ±2.6) vs (10.5 ± 1.4),(1 620 ±309) dyne · s · m2/cm5 vs (1 346 ±233) dyne · s · m2/cm5;T6 point:(136 ± 15) times/min vs (98 ± 13) times/min,(11.9 ±2.0) vs (9.6 ± 1.3),(1 587 ±319) dyne· s· m2/cm5 vs (1 36l ± 249) dyne · s · m2/cm5;T7 point:(134 ± 15) times/min vs (95±14) times/min,(12.0 ±2.7) vs (9.4 ± 1.4),(1 547 ±280) dyne · s · m2/cm5 vs (1 402 ±404) dyne · s · m2/cm5];SVI and CI in S group were significantly lower than those in SM group [T3 point:(22±6) ml/m2 vs (31 ±11) ml/m2,(2.9±0.7) L/(min · m2) vs (3.1 ±0.9) L/(min · m2);T4 point:(21 ±5) ml/m2 vs (35±12) ml/m2,(2.9±0.7) L/(min · m2) vs (3.8±1.0) L/(min · m2);T5 point:(22±6) ml/m2 vs (36±12) ml/m2,(2.9 ±0.7) L/(min · m2) vs (3.7 ±0.9) L/(min · m2);T6 point:(21 ±7) ml/m2 vs (37±12) ml/m2,(2.8±0.7) L/(min· m2) vs (3.6±0.9) L/(min· m2);T7 point:(22 ±6) ml/m2 vs (40 ± 12) ml/m2,(3.0 ±0.6) L/(min · m2) vs (3.7 ±0.8) L/(min · m2)] (P ＜0.05).Conclusions Total inhalation anesthesia with sevoflurane can keep hemodynamics stable and is more effective in attenuating the cardiovascular intubation response.Sufentanil-midazolam anesthesia shows less inhibition on hemodynamics than sevoflurane and may be more valuable in critically ill children with low cardiac output.
Keywords：Congenital heart defectsHemodynamicsSevoflurane
Publication Date：2015-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：4( 1427-1430 )