Pérez E Rodríguez, Bartolomé F Benito, Carretero P Sanabria, Fernández C Sánchez, Mateos E Jiménez, Tarlovsky L Goldman
Servicio de Anestesia y Reanimación Infantil, Hospital Infantil La Paz, Madrid.
Rev Esp Anestesiol Reanim. 2008 Jan;55(1):26-31. doi: 10.1016/s0034-9356(08)70494-8.
To evaluate the electrophysiological effects of sevoflurane in children with Wolff-Parkinson-White (WPW) syndrome undergoing radiofrequency ablation.
We performed a prospective study of 15 patients with WPW syndrome who were scheduled for an electrophysiological study (EPS) and radiofrequency ablation. Anesthesia was induced with fentanyl (2 microg/kg), propofol (3 mg/kg), and vecuronium (0.1 mg/kg), and initially maintained using propofol (100 microg/kg), with bolus administration of fentanyl and vecuronium as required. Four intracardiac catheters were introduced for the EPSpropofol, which included measurements of sinus-node function, sinoatrial-node conduction, refractory periods (atrial, AV-node, accessory pathway anterograde and retrograde, and ventricular), and the characteristics of induced orthodromic tachycardia. The propofol was then replaced with sevoflurane (1 MAC adjusted for age) and the measurements were repeated (EPSsevoflurane). The EPSpropofol and EPSsevoflurane data were compared using the Wilcoxon signed-rank test.
The mean (SD) age was 9.3 (6) years. After administration of sevoflurane, the duration of the antegrade effective refractory period of the accessory pathway increased (EPSpropofol, 283 (22) ms; EPSsevoflurane, 298 (25) ms; P = .004), as did the duration of the minimum pacing cycle with 1:1 atrioventricular conduction (EPSpropofol, 244 (41) ms; EPSsevoflurane, 273 (28) ms; P = .028). No significant changes were observed in the other parameters. Ablation of the accessory pathway was achieved in all patients.
Sevoflurane partially modified the properties of the accessory pathway but did not prevent ablation.
评估七氟醚对患有预激综合征（WPW）的儿童在接受射频消融术时的电生理效应。
我们对15例计划进行电生理研究（EPS）和射频消融术的WPW综合征患者进行了一项前瞻性研究。采用芬太尼（2微克/千克）、丙泊酚（3毫克/千克）和维库溴铵（0.1毫克/千克）诱导麻醉，最初使用丙泊酚（100微克/千克）维持，并根据需要推注芬太尼和维库溴铵。插入四根心内导管用于EPS丙泊酚，包括测量窦房结功能、窦房结传导、不应期（心房、房室结、附加通路前传和逆传以及心室）以及诱发的顺向性心动过速的特征。然后将丙泊酚替换为七氟醚（根据年龄调整为1 MAC），并重复测量（EPS七氟醚）。使用Wilcoxon符号秩检验比较EPS丙泊酚和EPS七氟醚的数据。
平均（标准差）年龄为9.3（6）岁。给予七氟醚后，附加通路前传有效不应期的持续时间增加（EPS丙泊酚，283（22）毫秒；EPS七氟醚，298（25）毫秒；P = 0.004），1:1房室传导的最小起搏周期持续时间也增加（EPS丙泊酚，244（41）毫秒；EPS七氟醚，273（28）毫秒；P = 0.028）。其他参数未观察到显著变化。所有患者均成功消融附加通路。
七氟醚部分改变了附加通路的特性，但并未妨碍消融。
