Han Ding, Liu Ya-Guang, Pan Shou-Dong, Luo Yi, Li Jia, Ou-Yang Chuan
Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China.
Anesthesia Center, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China.
Heart Surg Forum. 2019 Feb 18;22(1):E038-E044. doi: 10.1532/hsf.2037.
Background Intravenous sufentanil-midazolam and inhalational sevoflurane are widely used for anesthetic induction in children undergoing cardiac surgery. However, knowledge about their effects on hemodynamics and cardiac efficiency remains limited due largely to the lack of direct monitoring method. We used minimally invasive technique pressure recording analytical method (PRAM) to directly monitor hemodynamics and cardiac efficiency and compared the effects of the two anesthetic regimens in children undergoing ventricular septal defect repair. Methods Forty-Four children (2.3±0.9 years) were randomly divided into two groups to receive either intravenous sufentanil (1 μg/kg) and midazolam (0.2 mg/kg) (Group SM) or 2.0 minimal alveolar concentration (MAC) sevoflurane (Group S) to complete induction after sedation was obtained with 2.0 MAC sevoflurane. Systemic hemodynamic data recorded by PRAM included heart rate (HR), systolic (SBP) and mean (MBP) blood pressure, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) and cardiac cycle efficiency (CCE) after sedation obtained, 1, 2, 5 min after induction achieved, 1, 2, 5 and 10 min after intubation. Results HR, SVRI showed a decrease in Group SM but an increase in Group S (Ptimegroup<0.0001) in the study period. SVI and CCE showed an increase in Group SM but a decrease in Group S (Ptimegroup<0.0001). SBP, MBP and CI were related to time after polynomial transformation, and showed an increase after intubation in Group SM but a decrease in Group S (Ptime2*group<0.0001). Conclusion PRAM provides meaningful and direct monitoring of hemodynamics and cardiac efficiency during the dynamic period of anesthetic induction in children undergoing cardiac surgery. As compared to inhalational sevoflurane, intravenous sufentanil-midazolam exerts more favorable effects on systemic hemodynamics and cardiac efficiency during anesthetic induction in this group of patients.
背景 静脉注射舒芬太尼-咪达唑仑和吸入七氟醚广泛用于心脏手术患儿的麻醉诱导。然而，由于缺乏直接监测方法，关于它们对血流动力学和心脏效率影响的了解仍然有限。我们采用微创技术压力记录分析法（PRAM）直接监测血流动力学和心脏效率，并比较这两种麻醉方案对室间隔缺损修补术患儿的影响。方法 44例患儿（2.3±0.9岁）随机分为两组，分别接受静脉注射舒芬太尼（1μg/kg）和咪达唑仑（0.2mg/kg）（SM组）或2.0最低肺泡有效浓度（MAC）的七氟醚（S组），在给予2.0MAC七氟醚镇静后完成诱导。PRAM记录的全身血流动力学数据包括心率（HR）、收缩压（SBP）和平均血压（MBP）、每搏量指数（SVI）、心脏指数（CI）、全身血管阻力指数（SVRI）、收缩期上升最大斜率（dp/dtmax）和心动周期效率（CCE），分别于镇静后、诱导完成后1、2、5分钟、插管后1、2、5和10分钟记录。结果 在研究期间，SM组HR、SVRI降低，而S组升高（P时间组<0.0001）。SM组SVI和CCE升高，而S组降低（P时间组<0.0001）。经多项式转换后，SBP、MBP和CI与时间相关，SM组插管后升高，而S组降低（P时间2*组<0.0001）。结论 PRAM为心脏手术患儿麻醉诱导动态期的血流动力学和心脏效率提供了有意义的直接监测。与吸入七氟醚相比，静脉注射舒芬太尼-咪达唑仑在该组患者麻醉诱导期间对全身血流动力学和心脏效率产生更有利的影响。
