Banga Priya, Negi Sunder L, Mandal Banashree, Barwad Parag, Saini Kulbhushan, Gourav Krishna P
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ann Card Anaesth. 2025 Jan 1;28(1):33-38. doi: 10.4103/aca.aca_19_24. Epub 2025 Jan 24.
Congenital heart diseases (CHDs) are not rare and often require an intervention at some point of time. Pediatric cardiac catheterization, a minimally invasive procedure, is performed to diagnose and to correct many cardiac abnormalities. Deep sedation with spontaneously breathing patients is the preferred technique for pediatric catheterization in the pediatric population. Therefore, the author aimed to find the best combination of drugs for pediatric cardiac catheterization procedures using dexmedetomidine-propofol (DP) and ketamine-propofol (KP).
Cyanotic and acyanotic CHD children, weighing 5-20 kg and undergoing sedation for cardiac catheterization, were randomly assigned into two groups. DP group children received a bolus intravenous (IV) propofol at 1 mg/kg body weight followed by 1 mcg/kg dexmedetomidine over 10 minutes. KP group children received a bolus IV propofol 1 mg/kg followed by ketamine 1 mg/kg over 10 minutes. For maintenance in the DP group, propofol infusion at 1.5 to 2 mg/kg/h and dexmedetomidine at 0.5 mcg/kg/h was started. In the KP group, propofol infusion at 1.5 to 2 mg/kg/h and ketamine at 1 mg/kg/h was started as maintenance. The bispectral index (BIS) was monitored throughout the procedure, and the BIS value was maintained between 60 and 80. Propofol top of 1 mg/kg was administered when the BIS value became more than 80 or when the child moved during the femoral vessel puncture or when the child moved during the procedure.
The mean time for regain of consciousness was faster (P < 0.005) in the KP group (11.02 ± 11.98) compared to the DP group (21.62 ± 18.68). BIS was monitored throughout the procedure; BIS values were lower (P < 0.001) in the DP group (60.0 ± 11.1) as compared to the KP group (73.7 ± 5.6). The cumulative doses of propofol in the KP group and DP group were comparable. Total fentanyl consumptions in the intraoperative period in the KP group and DP group were comparable (P > 0.001). There was no difference in drug side effects between the groups.
The KP combination had fast and early recovery compared to the DP combination in children who underwent the cardiac catheterization procedure under sedation in children undergoing cardiac catheterization procedures requiring sedation.
先天性心脏病（CHD）并不罕见，且常常在某个时间点需要进行干预。儿科心导管插入术是一种微创手术，用于诊断和纠正多种心脏异常。对于儿科患者，在自主呼吸的情况下进行深度镇静是儿科心导管插入术的首选技术。因此，作者旨在找出使用右美托咪定 - 丙泊酚（DP）和氯胺酮 - 丙泊酚（KP）进行儿科心导管插入术的最佳药物组合。
体重5 - 20千克、因心导管插入术而接受镇静的青紫型和非青紫型CHD患儿被随机分为两组。DP组患儿先静脉注射1毫克/千克体重的丙泊酚推注剂量，随后在10分钟内静脉注射1微克/千克的右美托咪定。KP组患儿先静脉注射1毫克/千克的丙泊酚推注剂量，随后在10分钟内静脉注射1毫克/千克的氯胺酮。在DP组，开始以1.5至2毫克/千克/小时的速度输注丙泊酚，并以0.5微克/千克/小时的速度输注右美托咪定进行维持。在KP组，开始以1.5至2毫克/千克/小时的速度输注丙泊酚，并以1毫克/千克/小时的速度输注氯胺酮进行维持。在整个手术过程中监测脑电双频指数（BIS），并将BIS值维持在60至80之间。当BIS值超过80时，或在股血管穿刺期间患儿移动时，或在手术过程中患儿移动时，给予1毫克/千克的丙泊酚追加剂量。
与DP组（21.62 ± 18.68）相比，KP组（11.02 ± 11.98）意识恢复的平均时间更快（P < 0.005）。在整个手术过程中监测BIS；与KP组（73.7 ± 5.6）相比，DP组（60.0 ± 11.1）的BIS值更低（P < 0.001）。KP组和DP组丙泊酚的累积剂量相当。KP组和DP组术中芬太尼的总消耗量相当（P > 0.001）。两组之间药物副作用无差异。
在需要镇静的儿科心导管插入术患儿中，与DP组合相比，KP组合恢复更快且更早。
