Department of Anesthesiology, Critical Care and Pain Medicine, Division of Cardiac Anesthesia, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Department of Anesthesiology, Critical Care and Pain Medicine, Division of Cardiac Anesthesia, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
J Clin Anesth. 2018 Nov;50:14-17. doi: 10.1016/j.jclinane.2018.06.022. Epub 2018 Jun 21.
Appropriate agent selection in patients with congenital heart disease (CHD) undergoing cardiac surgery and catheterization have been extensively reviewed in the literature. To date, there has not been an analysis of induction drug choices made in a large group of CHD patients undergoing non-cardiac procedures and intraoperative events. The primary objective was to characterize induction agent selection in CHD patients undergoing non-cardiac procedures and examine its association with intraoperative events.
Retrospective chart review analysis.
A single center study.
Children with CHD who underwent non-cardiac procedures.
INTERVENTION/MEASUREMENT: Using the electronic preoperative anesthesia evaluation form we identified 2966 cases performed under general anesthesia. We examined the association between patient characteristics (ASA PS and CHD severity) and induction drugs using multinominal logistic regression test. We also examined the association of induction drugs with intraoperative adverse events using Fisher exact test.
Inhalational and intravenous inductions were conducted in 35.7% and 64.3% of general anesthesia cases, respectively. Sevoflurane was the main inhalation induction drug. Propofol was used as the induction agent in 54.3% of cases, while etomidate, midazolam/fentanyl, and ketamine were used as the induction agent in 18.3% 16.6%, and 10.1% of cases, respectively. ASA PS and CHD severity predicted induction drugs better than single ventricle status or ventricular function. Intraoperative inotrope use was seen more frequently in cases induced by ketamine, etomidate or opioids over sevoflurane or propofol.
Patients with higher ASA classes and CHD of more severity tend to be induced more with etomidate, ketamine or opioids over sevoflurane or propofol. Use of etomidate, ketamine or opioids was more associated with inotrope use, but there was not significant difference in respiratory events among different induction agents. Causative association needs to be examined in the future.
在接受心脏手术和导管插入术的先天性心脏病（CHD）患者中，适当的药物选择已在文献中广泛综述。迄今为止，尚未对接受非心脏手术的大量 CHD 患者的诱导药物选择进行分析，也未对术中事件进行分析。主要目的是描述 CHD 患者接受非心脏手术时的诱导药物选择，并检查其与术中事件的关系。
回顾性图表审查分析。
单中心研究。
接受非心脏手术的 CHD 患儿。
干预/测量：使用电子术前麻醉评估表，我们确定了 2966 例在全身麻醉下进行的病例。我们使用多项逻辑回归检验检查了患者特征（ASA PS 和 CHD 严重程度）与诱导药物之间的关系。我们还使用 Fisher 精确检验检查了诱导药物与术中不良事件的关系。
全身麻醉中分别进行吸入诱导和静脉诱导的比例为 35.7%和 64.3%。七氟醚是主要的吸入诱导药物。丙泊酚作为诱导药物在 54.3%的病例中使用，而依托咪酯、咪达唑仑/芬太尼和氯胺酮在 18.3%、16.6%和 10.1%的病例中作为诱导药物使用。ASA PS 和 CHD 严重程度比单心室状态或心室功能更能预测诱导药物的使用。与七氟醚或丙泊酚相比，使用氯胺酮、依托咪酯或阿片类药物诱导的病例中，术中使用正性肌力药物更为常见。
ASA 分级较高和 CHD 严重程度较高的患者倾向于使用依托咪酯、氯胺酮或阿片类药物而非七氟醚或丙泊酚进行诱导。使用依托咪酯、氯胺酮或阿片类药物与使用正性肌力药物更为相关，但不同诱导药物之间的呼吸事件无显著差异。未来需要进一步检查因果关系。
