Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA.
Anesth Analg. 2010 Nov;111(5):1259-63. doi: 10.1213/ANE.0b013e3181f2eacf. Epub 2010 Aug 24.
Bradycardia is a complication associated with inhaled induction of anesthesia with halothane in children with Down syndrome. Although bradycardia has been reported after anesthetic induction with sevoflurane in these children, the incidence is unknown.
In this study we compared the incidence and characteristics of bradycardia after induction of anesthesia with sevoflurane in children with Down syndrome to healthy controls.
We reviewed electronic anesthetic records of 209 children with Down syndrome and 268 healthy control patients who had inhaled induction of anesthesia with sevoflurane over an 8-year period. Data extracted from the medical record included demographics, history of congenital heart disease, heart rate, oxyhemoglobin saturation, expired sevoflurane concentrations, arterial blood pressure, and any treatment of bradycardia during the first 360 seconds after the start of induction of anesthesia. Bradycardia and hypotension were defined as heart rate and arterial blood pressure below the critical limits recommended for activating a pediatric rapid response team to the bedside of a hospitalized child for quick intervention. Factors associated with bradycardia were identified in a univariate analysis. A step-wise backward multiple logistic regression model was used to identify independent factors. Differences between the 2 groups were computed using Fisher's exact test or χ(2) tests for categorical data and t tests for continuous data.
Univariate analysis demonstrated that Down syndrome, low ASA physical status, congenital heart disease, and mean sevoflurane concentrations were factors associated with bradycardia. However, multivariate analysis showed that only Down syndrome and low ASA physical status remained as independent factors associated with bradycardia.
Bradycardia during anesthetic induction with sevoflurane was common in children with Down syndrome, with and without a history of congenital heart disease.
患有唐氏综合征的儿童在使用氟烷吸入诱导麻醉时会出现心动过缓等并发症。虽然在这些儿童中使用七氟醚诱导麻醉后也曾有报道心动过缓，但发生率尚不清楚。
本研究比较了患有唐氏综合征的儿童与健康对照者在七氟醚吸入诱导麻醉后心动过缓的发生率和特征。
我们回顾了 209 名唐氏综合征儿童和 268 名健康对照者在 8 年期间使用七氟醚吸入诱导麻醉的电子麻醉记录。从病历中提取的数据包括人口统计学资料、先天性心脏病史、心率、氧合血红蛋白饱和度、呼出的七氟醚浓度、动脉血压以及在诱导麻醉开始后的前 360 秒内对心动过缓的任何治疗措施。心动过缓与低血压定义为心率和动脉血压低于激活儿科快速反应小组到住院患儿床边进行快速干预的临界下限。采用单变量分析确定与心动过缓相关的因素。使用逐步后退多变量逻辑回归模型确定独立因素。采用 Fisher 确切检验或卡方检验比较二分类变量，采用 t 检验比较连续变量。
单变量分析表明唐氏综合征、ASA 身体状况低、先天性心脏病和平均七氟醚浓度是心动过缓的相关因素。然而，多变量分析表明，只有唐氏综合征和 ASA 身体状况低仍然是与心动过缓相关的独立因素。
无论是否有先天性心脏病病史，唐氏综合征儿童在使用七氟醚诱导麻醉时均常发生心动过缓。
