Mikus Marian, Welchowski Thomas, Schindler Ehrenfried, Schneider Martin, Mini Nathalie, Vergnat Mathieu
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany.
J Clin Med. 2021 Nov 30;10(23):5648. doi: 10.3390/jcm10235648.
Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old.
We conducted a monocentric, retrospective study of all catheterization procedures (2008-2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables.
803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 ( = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) ( < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients ( = 0.05), smaller weights ( < 0.01), palliated status (OR 3.2 [1.2-8.9], = 0.02), two-ventricle physiology (OR 7.3 [2.7-20.2], < 0.01), cyanosis (OR 4.6 [2.2-9.8], < 0.01), pulmonary hypertension (OR 5.6 [2.0-15.5], < 0.01), interventional catheterization (OR 1.8 [1.1-3.2], = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8-455.1], = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2-12.0], < 0.01).
Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.
患有先天性心脏病的儿童需要反复进行心导管插入术。麻醉管理会影响手术过程，也可能影响手术结果；然而，针对婴儿的数据和建议却很匮乏。我们研究了镇静与全身麻醉（GA）对2岁以下儿童心导管插入术期间不良事件的影响。
我们对所有心导管插入术（2008 - 2013年）进行了一项单中心回顾性研究。使用倾向评分调整模型比较高严重度不良事件（HSAE）发生率，该模型包括术前和术中变量。
研究了803例病例（619名患者）（平均年龄6.9±6.1个月），其中368例（46%）接受GA，435例（54%）接受镇静。镇静后转为GA的比例为18例（4%）。GA或镇静后住院时间分别为4.9±4.0天和4.1±2.5天（P = 0.01）。GA组和镇静组HSAE发生率分别为75例（20%）和40例（9%）（P < 0.01）。危险因素（多变量分析）包括年龄较大的患者（P = 0.05）、体重较轻（P < 0.01）、姑息状态（OR 3.2 [1.2 - 8.9]，P = 0.02）、双心室生理状态（OR 7.3 [2.7 - 20.2]，P < 0.01）、发绀（OR 4.6 [2.2 - 9.8]，P < 0.01）、肺动脉高压（OR 5.6 [2.0 - 15.5]，P < 0.01）、介入性心导管插入术（OR 1.8 [1.1 - 3.2]，P = 0.02）和手术类型风险类别4（OR 28.9 [1.8 - 455.1]，P = 0.02）。镇静并未增加事件发生率，且降低了对血流动力学支持的需求（OR 5.2 [2.2 - 12.0]，P < 0.01）。
对于2岁以下儿童的心导管插入术，就HSAE而言，镇静与GA一样安全有效。镇静还降低了对血流动力学支持的需求。对于这个特定年龄组，已发现年龄较大和双心室生理状态等矛盾性风险影响。
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