Comparison by Real-Time Hemodynamic and Cardiac Efficiency Monitoring of Sufentanil-Midazolam and Sevoflurane for Anesthesia Induction in Children Undergoing Cardiac Surgery: A Prospective Randomized Study
DOI:
https://doi.org/10.1532/hsf.2037Abstract
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 a minimally invasive technique, the 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 randomized into two groups to receive either intravenous sufentanil (1 µg/kg) and midazolam (0.2 mg/kg) (Group SM) or 2.0 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, and 5 minutes after induction achieved; 1, 2, 5, and 10 minutes after intubation.
Results: HR and SVRI showed a decrease in Group SM but an increase in Group S (Ptime*group < 0.0001) in the study period. SVI and CCE showed an increase in Group SM but a decrease in Group S (Ptime*group < 0.0001). SBP, MBP, and CI were related to time after polynomial transformation, showing 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 hemodynamic parameters as well as 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.
References
Alonso-Inigo JM, Escriba FJ, Carrasco JI, et al. 2016. Measuring cardiac output in children undergoing cardiac catheterization: comparison between the Fick method and PRAM (pressure recording analytical method). Paediatr Anaesth 26:1097-105.
Chen CH, Fetics B, Nevo E, et al. 2001. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol 38:2028-34.
Coetzee A, Fourie P, Coetzee J, et al. 1989. Effect of various propofol plasma concentrations on regional myocardial contractility and left ventricular afterload. Anesth Analg 69:473-83.
Deryck YL, Fonck K, L DEB, et al. 2010. Differential effects of sevoflurane and propofol anesthesia on left ventricular-arterial coupling in dogs. Acta Anaesthesiol Scand 54:979-86.
Giglioli C, Nesti M, Cecchi E, et al. 2013. Hemodynamic effects in patients with atrial fibrillation submitted to electrical cardioversion. Int J Cardiol 168:4447-50.
Girotra S, Singh A, Mehta Y, et al. 1999. Sevoflurane for induction and intubation in children undergoing congenital cardiac surgery. Ann Card Anaesth 2:27-30.
Glenski JA, Friesen RH, Hassanein RS, et al. 1988. Comparison of the hemodynamic and echocardiographic effects of sufentanil, fentanyl, isoflurane, and halothane for pediatric cardiovascular surgery. J Cardiothorac Anesth 2:147-55.
Hettrick DA, Pagel PS, Warltier DC. 1996. Desflurane, sevoflurane, and isoflurane impair canine left ventricular-arterial coupling and mechanical efficiency. Anesthesiology 85:403-13.
Hoeft A, Sonntag H, Stephan H, et al. 1994. The influence of anesthesia on myocardial oxygen utilization efficiency in patients undergoing coronary bypass surgery. Anesth Analg 78:857-66.
Ikeda K, Ikeda T, Herregods L, et al. 1989. A comparison of hemodynamic changes with sufentanil-O2 and fentanyl-O2 anesthesia for coronary bypass grafting. Masui 38:1469-74.
Ikemba CM, Su JT, Stayer SA, et al. 2004. Myocardial performance index with sevoflurane-pancuronium versus fentanyl-midazolam-pancuronium in infants with a functional single ventricle. Anesthesiology 101:1298-305.
Inomata S, Yamashita S, Toyooka H, et al. 1998. Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children. Anaesthesia 53:440-5.
Joshi A, Lee S, Pawar D. 2012. An optimum time for intravenous cannulation after induction with sevoflurane in children. Paediatr Anaesth 22:445-8.
Kern C, Erb T, Frei FJ. 1997. Haemodynamic responses to sevoflurane compared with halothane during inhalational induction in children. Paediatr Anaesth 7:439-44.
Khosroshahi HE, Ozkan EA, Kilic M. 2014. Arterial and left ventricular end-systolic elastance in normal children. Eur Rev Med Pharmacol Sci 18:3260-6.
Laird TH, Stayer SA, Rivenes SM, et al. 2002. Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolam with 100% oxygen in children with congenital heart disease. Anesth Analg 95:1200-6.
Lina AA, Dauchot PJ, Anton AH. 1996. Sufentanil with and without diazepam for coronary artery bypass graft surgery. Acta Anaesthesiol Belg 47:177-85.
Nagata H, Ihara K, Yamamura K, et al. 2013. Left ventricular efficiency after ligation of patent ductus arteriosus for premature infants. J Thorac Cardiovasc Surg 146:1353-8.
Newman M, Reves JG. 1993. Pro: midazolam is the sedative of choice to supplement narcotic anesthesia. J Cardiothorac Vasc Anesth 7:615-9.
Nusmeier A, Van Der Hoeven JG, Lemson J. 2010. Cardiac output monitoring in pediatric patients. Expert Rev Med Devices 7:503-17.
Onorati F, Santini F, Dandale R, et al. 2013. “Polarizing” microplegia improves cardiac cycle efficiency after CABG for unstable angina. Int J Cardiol 167:2739-46.
Prabhu SD. 2007. Altered left ventricular-arterial coupling precedes pump dysfunction in early heart failure. Heart Vessels 22:170-7.
Prakanrattana U, Suksompong S. 2002. Comparison of sufentanil and fentanyl for surgical repair of congenital cardiac defects. J Med Assoc Thai 85 Suppl 3:S807-14.
Rivenes SM, Lewin MB, Stayer SA, et al. 2001. Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease: an echocardiographic study of myocardial contractility and hemodynamics. Anesthesiology 94:223-9.
Romagnoli S, Romano M, Lazzeri C, et al. 2010. Cardiac cycle efficiency: a new index for cardiac work estimation tested during aortic valve plasty. Critical Care 14:P127.
Romano SM, Pistolesi M. 2002. Assessment of cardiac output from systemic arterial pressure in humans. Crit Care Med 30:1834-41.
Romano SM, Olivotto I, Chiostri M, et al. 2006. Minimally Invasive and Noninvasive Hemodynamic Monitoring of the Cardiovascular System: Available Options and Future Perspectives. Current Cardiol Rev 2:37-9.
Romano SM. 2012. Cardiac cycle efficiency: a new parameter able to fully evaluate the dynamic interplay of the cardiovascular system. Int J Cardiol 155:326-7.
Saxena R, Durward A, Puppala NK, et al. 2013. Pressure recording analytical method for measuring cardiac output in critically ill children: a validation study. Br J Anaesth 110:425-31.
Scolletta S, Ranaldi G, Carlucci F, et al. 2010. Relationship between N-terminal pro-B-type natriuretic peptide (Nt-proBNP) and cardiac cycle efficiency in cardiac surgery. Biomed Pharmacother 64:511-5.
Scolletta S, Bodson L, Donadello K, et al. 2013. Assessment of left ventricular function by pulse wave analysis in critically ill patients. Intensive Care Med 39:1025-33.
Sivarajan VB, Bohn D. 2011. Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatr Crit Care Med 12:S2-11.
Urbano J, Lopez J, Gonzalez R, et al. 2015. Measurement of cardiac output in children by pressure-recording analytical method. Pediatr Cardiol 36:358-64.
Wang KY, Wang HW, Xin LF, et al. 2011. Evaluation of high-concentration sevoflurane for induction and nasotracheal intubation without muscle relaxant for infants with different pulmonary blood flow undergoing surgery for congenital heart diseases. Chin Med J (Engl) 124:4144-8.
Xue FS, Liu KP, Liu Y, et al. 2007. Assessment of small-dose fentanyl and sufentanil blunting the cardiovascular responses to laryngoscopy and intubation in children. Paediatr Anaesth 17:568-74.
Zeyneloglu P, Donmez A, Sener M. 2008. Sevoflurane induction in cyanotic and acyanotic children with congenital heart disease. Adv Ther 25:1-8
