Gozal D, Rein A J, Nir A, Gozal Y
Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital and the Hebrew University School of Medicine, Post Office Box 12000, Jerusalem 91120, Israel.
Pediatr Cardiol. 2001 Nov-Dec;22(6):488-90. doi: 10.1007/s002460010280. Epub 2001 Dec 4.
Immobility and cardiovascular stability are required for cardiac catheterization. Pediatric patients need a type of sedation that also allows spontaneous ventilation without supplemental oxygen. Propofol has been adequate in hemodynamically stable patients with congenital heart disease undergoing cardiac catheterization. However, mild systemic hypotension caused by propofol may increase a preexisting right-to-left shunt. The aim of this study is to evaluate, in pediatric patients scheduled for cardiac catheterization, the effects of propofol on systemic and pulmonic circulations. Fifteen patients aged 18 months to 9 years were studied. After a fast of 4-6 hours for solid food, the patient arrived at the cardiac catheterization suite, where an IV catheter was placed. Usual monitoring was used. For sedation, without supplemental oxygen, patients received 1 mg/kg of fentanyl followed by propofol (1-2 mg/kg) titrated to immobility during preparation of the groin. A continuous infusion of propofol (100 mg/kg/min) was also started to obtain immobility during the procedure. Hemodynamic data, including systemic venous, pulmonary artery and vein, aortic saturations, and pressures, were recorded; Qp and Qs were calculated. The same set of data was re-corded 4 minutes after discontinuation of propofol and when the patient was responding to tactile stimuli. Despite lower pressures during propofol infusion, as compared with those pressures measured after discontinuation of propofol, the extent of the intracardiac shunt remained unchanged. Propofol seems to be an adequate sedative agent for pediatric patients undergoing cardiac catheterization, including those with intracardiac shunts.
心脏导管插入术需要患者保持不动并维持心血管稳定。儿科患者需要一种能在不补充氧气的情况下仍允许自主通气的镇静方式。丙泊酚已被证明对于接受心脏导管插入术的血流动力学稳定的先天性心脏病患者是足够的。然而，丙泊酚引起的轻度全身性低血压可能会增加已存在的右向左分流。本研究的目的是评估在计划进行心脏导管插入术的儿科患者中，丙泊酚对体循环和肺循环的影响。研究了15名年龄在18个月至9岁之间的患者。在禁食4 - 6小时固体食物后，患者进入心脏导管插入术操作室，在那里放置静脉导管。采用常规监测。为了在不补充氧气的情况下进行镇静，患者先接受1mg/kg的芬太尼，随后在腹股沟准备过程中给予丙泊酚（1 - 2mg/kg）并根据患者不动程度进行滴定。在操作过程中还开始持续输注丙泊酚（100mg/kg/min）以维持患者不动。记录血流动力学数据，包括体静脉、肺动脉和肺静脉、主动脉饱和度以及压力；计算肺循环血流量（Qp）和体循环血流量（Qs）。在停用丙泊酚4分钟后以及患者对触觉刺激有反应时再次记录同一组数据。尽管在输注丙泊酚期间压力较低，但与停用丙泊酚后测量的压力相比，心内分流程度保持不变。丙泊酚似乎是适合接受心脏导管插入术的儿科患者的镇静剂，包括那些有心内分流的患者。
