Hasija Suruchi, Chauhan Sandeep, Jain Pawan, Choudhury Arin, Aggarwal Neelam, Pandey Ravinder Kumar
Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
Ann Card Anaesth. 2016 Jul-Sep;19(3):468-74. doi: 10.4103/0971-9784.185531.
Conduct of stable inhalational anesthetic induction in children with congenital heart disease (CHD) presents special challenges. It requires in-depth understanding of the effect of congenital shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs. Intracardiac shunts can alter the induction time and if delivery of anesthetic agent is not carefully titrated, can lead to overdosing and undesirable myocardial depression.
To study the effect of congenital shunt lesions on the speed of inhalational induction and also the impact of inhalational induction on hemodynamics in the presence of congenital shunt lesions.
Tertiary care hospital.
A prospective, single-center clinical study.
Ninety-three pediatric patients undergoing elective surgery were segregated into three equal groups, namely, Group 1: no CHD, Group 2: acyanotic CHD, and Group 3: cyanotic CHD. General anesthesia was induced with 8% sevoflurane in 6 L/min air-oxygen. The time to induction was noted at loss of eyelash reflex and decrease in bispectral index (BIS) value below 60. End-tidal sevoflurane concentration, minimum alveolar concentration, and BIS were recorded at 15 s intervals for the 1 st min followed by 30 s interval for another 1 min during induction. Hemodynamic data were recorded before and after induction.
Patients in Group 3 had significantly prolonged induction time (99 ± 12.3 s; P < 0.001), almost twice that of the patients in other two groups (51 ± 11.3 s in Group 1 and 53 ± 12.0 s in Group 2). Hypotension occurred after induction in Group 1. No other adverse hemodynamic perturbations were observed.
The time to inhalational induction of anesthesia is significantly prolonged in patients with right-to-left shunt, compared to patients without CHD or those with left-to-right shunt, in whom it is similar. Sevoflurane is safe and maintains stable hemodynamics in the presence of CHD.
对患有先天性心脏病（CHD）的儿童进行稳定的吸入麻醉诱导存在特殊挑战。这需要深入了解先天性分流病变对麻醉药物摄取、输送和平衡的影响。心内分流可改变诱导时间，如果麻醉剂的输送未仔细滴定，可能导致用药过量和不良的心肌抑制。
研究先天性分流病变对吸入诱导速度的影响，以及在存在先天性分流病变的情况下吸入诱导对血流动力学的影响。
三级护理医院。
一项前瞻性、单中心临床研究。
93例接受择期手术的儿科患者被分为三组，每组人数相等，即：第1组：无CHD；第2组：非紫绀型CHD；第3组：紫绀型CHD。采用8%七氟醚在6L/min的空气-氧气中诱导全身麻醉。记录睫毛反射消失和脑电双频指数（BIS）值降至60以下时的诱导时间。诱导期间，在第1分钟内每隔15秒记录呼气末七氟醚浓度、最低肺泡浓度和BIS，随后在接下来的1分钟内每隔30秒记录一次。记录诱导前后的血流动力学数据。
第3组患者的诱导时间显著延长（99±12.3秒；P<0.001），几乎是其他两组患者诱导时间的两倍（第1组为51±11.3秒，第2组为53±12.0秒）。第1组诱导后出现低血压。未观察到其他不良血流动力学干扰。
与无CHD或有左向右分流的患者相比，有右向左分流的患者吸入麻醉诱导时间显著延长，而后两者相似。七氟醚在存在CHD的情况下是安全的，并能维持稳定的血流动力学。
