Comparison of hemodynamic effects of sevoflurane and ketamine as basal anesthesia by a new and direct monitoring during induction in children with ventricular septal defect

Ding, Heyu; Liu, Yaguang; Pan, Shoudong; Luo, Yi; Li, Jia; Ouyang, Chuying

doi:10.1097/md.0000000000009039

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Abstracts for these 93 manuscripts were reviewed and a total of 42 had their full‐text reviewed after elimination of animal studies, review articles, non‐English studies, and studies not pertaining to the question of our review. A total of 7 studies with 139 patients were identified for inclusion in the meta‐analyses (Figure ) . Pre‐ and postketamine hemodynamic data were available for the 139 patients included in the final review.…”

Section: Resultsmentioning

confidence: 99%

“…A total of five studies presented data regarding cardiac index . These provided data from 104 patients.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 7 studies with 139 patients were identified for inclusion in the meta-analyses ( Figure 1). [9][10][11][12][13][14][15] Pre-and postketamine hemodynamic data were available for the 139 patients included in the final review. Only study level data were available and no patient level data were available.…”

Section: Manuscript Identification and Characteristicsmentioning

confidence: 99%

“…All seven studies presented data regarding systemic vascular resistance. [9][10][11][12][13][14][15] These provided data from 139 patients. The P value for the Q statistic was <.001 and the I 2 -statistic was 78%, demonstrating significant heterogeneity.…”

Section: Systemic Vascular Resistancementioning

confidence: 99%

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Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Loomba

Gray

Flores

2018

Congenital Heart Disease

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Introduction Ketamine is a drug often used for procedural sedation or as adjunct agent for general sedation in children with congenital heart disease. In the clinical realm, there is often confusion regarding the effects of ketamine on hemodynamics, particularly pulmonary vascular resistance and systemic vascular resistance. We performed a meta‐analysis of studies investigating the effects of ketamine on hemodynamics. Methods A systematic review was conducted to identify studies characterizing the hemodynamic effects of ketamine in children with congenital heart disease. Studies were assessed for quality and those of satisfactory quality with pre‐ and postketamine hemodynamics for each patient were included in the final analyses. Those not limited to pediatric patients and those not limited to patients with congenital heart disease were excluded from the final analyses. Results A total of 7 studies with 139 patients were included in the final analyses. Pulmonary vascular resistance, systemic vascular resistance, mean pulmonary artery pressure, mean systemic pressure, heart rate, pH, and arterial oxygen concentration did not significantly change with administration of ketamine. Carbon dioxide concentration did increase significantly by a mean of 1.38 mm Hg with the administration of ketamine. Conclusion Ketamine has minimal impact on hemodynamics in children with congenital heart disease when used at usual clinical doses. Systemic vascular resistance and pulmonary vascular resistance are not significantly altered. Blood gas values are also only minimally affected by ketamine.

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Section: Resultsmentioning

confidence: 99%

“…A total of five studies presented data regarding cardiac index . These provided data from 104 patients.…”

Section: Resultsmentioning

confidence: 99%

Section: Manuscript Identification and Characteristicsmentioning

confidence: 99%

Section: Systemic Vascular Resistancementioning

confidence: 99%

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Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Loomba

Gray

Flores

2018

Congenital Heart Disease

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“…Sevoflurane preconditioning exerts cardioprotection and inhibits p38 activation in an AMPK-dependent manner with increased ERK1/2 activation, which may be an effective approach to reducing perioperative cardiac injury in diabetic patients [21]. Studies of sevoflurane in adults and in healthy children suggest that it may have significant advantages in infants and children with heart disease [22,23]. Nonetheless, to the best of our knowledge, the protective effects and mechanisms of propofol vs.…”

Section: Original Papermentioning

confidence: 99%

Comparison of Cardioprotective Effects of Propofol versus Sevoflurane in Pediatric Living Donor Liver Transplantation

Weng

Yuan

Yu³

2020

Ann Transplant

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Background:Our study compared the myocardiac protective effect of propofol vs. sevoflurane in pediatric patients receiving living donor liver transplantation (LDLT) surgery. Material/Methods:We randomly and equally divided 120 children who underwent LDLT into a sevoflurane group and a propofol group. Preoperative, intraoperative, and postoperative data were collected and compared between the 2 groups. The concentrations of cTnI, CK-MB, IL-6, TNF-a, and HMGB1 at 5 min after induction (T0), 30 min in the anhepatic period (T1), and 3 h after reperfusion (T2), and at the end of surgery (T3) were measured. Results:There was no statistically significant difference in the characteristics of children in the 2 groups. Compared with T0, the levels of IL-6 and TNF-a at T1, T2, and T3 were higher, while the HMGB1 at T2 and T3 were higher (P<0.05). A similar trend for IL-6, TNF-a, and HMGB1 at different time points in the 2 groups was observed.Compared with T0, the cTnI and CK-MB at T2 and T3 were significantly higher (P<0.05), but there was no significant difference at different time points in the 2 groups. For the adverse events, there was no significant difference between the 2 groups. Conclusions:Our study shows that the cardioprotective effect in pediatric patients undergoing living donor liver transplantation is similar with propofol and sevoflurane anesthesia.

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Factors associated with the need for inotropic support following pulmonary artery banding surgery for CHD

et al. 2023

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Objective: We aimed to identify factors independently associated with the need for inotropic support for low cardiac output or haemodynamic instability after pulmonary artery banding surgery for CHD. Methods: We performed a retrospective chart review of all neonates and infants who underwent pulmonary banding between January 2016 and June 2019 at our institution. Bivariate and multivariable analyses were performed to identify factors independently associated with the use of post-operative inotropic support, defined as the initiation of inotropic infusion(s) for depressed myocardial function, hypotension, or compromised perfusion within 24 hours of pulmonary artery banding. Results: We reviewed 61 patients. Median age at surgery was 10 days (25%,75%:7,30). Cardiac anatomy was biventricular in 38 patients (62%), hypoplastic right ventricle in 14 patients (23%), and hypoplastic left ventricle in 9 patients (15%). Inotropic support was implemented in 30 patients (49%). Baseline characteristics of patients who received inotropic support, including ventricular anatomy and pre-operative ventricular function, were not statistically different from the rest of the cohort. Patients who received inotropic support, however, were exposed to larger cumulative doses of ketamine intraoperatively – median 4.0 mg/kg (25%,75%:2.8,5.9) versus 1.8 mg/kg (25%,75%:0.9,4.5), p < 0.001. In a multivariable model, cumulative ketamine dose greater than 2.5mg/kg was associated with post-operative inotropic support (odds ratio 5.5; 95% confidence interval: 1.7,17.8), independent of total surgery time. Conclusions: Inotropic support was administered in approximately half of patients who underwent pulmonary artery banding and more commonly occurred in patients who received higher cumulative doses of ketamine intraoperatively, independent of the duration of surgery.

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Comparison of hemodynamic effects of sevoflurane and ketamine as basal anesthesia by a new and direct monitoring during induction in children with ventricular septal defect

Cited by 5 publications

References 27 publications

Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Comparison of Cardioprotective Effects of Propofol versus Sevoflurane in Pediatric Living Donor Liver Transplantation

Factors associated with the need for inotropic support following pulmonary artery banding surgery for CHD

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