Sungur Ulke Zerrin, Kartal Umut, Orhan Sungur Mukadder, Camci Emre, Tugrul Mehmet
Department of Anesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Paediatr Anaesth. 2008 Aug;18(8):715-21. doi: 10.1111/j.1460-9592.2008.02637.x.
Sevoflurane is widely used in pediatric anesthesia for induction. Ketamine has been preferred in pediatric cardiovascular anesthesia. Aim of this study was to compare the hemodynamic effects and the speed of ketamine and sevoflurane for anesthesia induction in children with congenital heart disease.
Children with congenital heart disease undergoing corrective surgery were included in the study. After oral premedication with midazolam (0.5 mg.kg(-1)), anesthesia induction was started with 5 mg.kg(-1) intramuscular ketamine (group K). In the second group, induction was achieved with sevoflurane (group S); the first concentration was 3% and increased after every three breaths. Intravenous access time and intubation times were enrolled for each child. Hemodynamic data and oxygen saturation were recorded every 2 min and any event during induction period was also noted.
Forty-seven children were included in the study; 23 in group K and 24 in group S. Heart rates and oxygen saturation values were similar between groups during the study. No difference was found between intravenous access time and intubation times. However, blood pressure levels were significantly lower in group S after recording baseline values till the intubation time (at 4, 6, and 8 min). Respiratory complications observed during the study were mild and were less frequent in group K than in group S (4 vs 13).
Ketamine appears a good alternative for induction in patients with congenital heart disease. It permits preservation of hemodynamic stability with minimal side effects.
七氟醚广泛用于小儿麻醉诱导。氯胺酮一直是小儿心血管麻醉的首选药物。本研究的目的是比较氯胺酮和七氟醚对先天性心脏病患儿麻醉诱导时的血流动力学影响及诱导速度。
纳入接受矫正手术的先天性心脏病患儿。口服咪达唑仑（0.5mg·kg⁻¹）进行术前用药后，第一组（K组）采用5mg·kg⁻¹氯胺酮肌肉注射开始麻醉诱导。第二组（S组）采用七氟醚诱导；初始浓度为3%，每呼吸3次后增加浓度。记录每个患儿的静脉穿刺时间和插管时间。每2分钟记录血流动力学数据和血氧饱和度，并记录诱导期的任何事件。
47名患儿纳入研究；K组23例，S组24例。研究期间两组患儿的心率和血氧饱和度值相似。静脉穿刺时间和插管时间无差异。然而，从记录基线值到插管时（4、6和8分钟），S组的血压水平显著低于K组。研究期间观察到的呼吸并发症较轻，K组比S组少见（4例对13例）。
氯胺酮似乎是先天性心脏病患儿诱导麻醉的良好替代药物。它能在副作用最小的情况下维持血流动力学稳定。
