Hemodynamic Effects of Ketamine in Children with Congenital Heart Disease

Morray, Jeffrey P.; Lynn, Anne M; Stamm, Stanley J.; Herndon, Paul; Kawabori, Isamu; Stevenson, James G.

doi:10.1097/00132586-198506000-00042

Cited by 34 publications

(31 citation statements)

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“…The right ventricle may dilate and develop worsening function and left ventricular failure with pulmonary regurgitation. 102 It is effective at maintaining the SVR, 110 yet does not significantly alter Q p /Q s . 34 It is now questionable whether complete relief of the right ventricular to pulmonary artery gradient is even necessary at the time of repair, because significant infundibular resection is needed to accomplish it, and more than a third of patients at long-term follow-up have been identified with pulmonary regurgitation.…”

Section: Tetralogy Of Fallot (Tof)mentioning

confidence: 99%

“…However, the need for pulmonary valve replacement is not absolute with pulmonary regurgitation, because it may be tolerated well for years. 102 Ketamine provides superior hemodynamic control compared with isoflurane in infants with TOF, not just during induction but with anesthetic maintenance as well. 148 Obstruction of the right ventricular outflow tract is not uncommon and is the most common reason for reoperation.…”

Section: Tetralogy Of Fallot (Tof)mentioning

confidence: 99%

“…102 Its effects are mediated through a centrally activated increase in sympathetic activity. 102 Its effects are mediated through a centrally activated increase in sympathetic activity.…”

mentioning

confidence: 99%

“…102 Its effects are mediated through a centrally activated increase in sympathetic activity. 102 It relaxes bronchial smooth muscle stimulated by endothelin. 67,68 In those with CHD undergoing cardiac catheterization, ketamine has been shown to increase HR but causes no change in Qp/Qs.…”

mentioning

confidence: 99%

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Congenital Heart Disease

Oliver¹,

Lynch²

2006

Anesthesia and Uncommon Diseases

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Section: Tetralogy Of Fallot (Tof)mentioning

confidence: 99%

Section: Tetralogy Of Fallot (Tof)mentioning

confidence: 99%

“…102 Its effects are mediated through a centrally activated increase in sympathetic activity. 102 Its effects are mediated through a centrally activated increase in sympathetic activity.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Congenital Heart Disease

Oliver¹,

Lynch²

2006

Anesthesia and Uncommon Diseases

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“…81 Changing to a newer, less familiar pharmacological agent may be more detrimental. Theoretically, sporadic use as a sedative before procedures should not be of major concern.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Pain Management and Conscious Sedation for the Pediatric Patient

Poon¹

1996

Journal of Pharmacy Practice

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Pain management in children was previously ignored primarily because of myths and misconceptions about childhood pain. Undertreatment of pain was once a common and accepted practice. However, in recent years, with increased knowledge and understanding coupled with improved pain assessment tools, health care providers are more conscious about providing adequate and safe analgesia to children. Because of the differences in patient response to various pharmacological agents, it is important to understand the pharmacokinetic and pharmacodynamic differences of the various agents. Choices of pain management should be individualized, and adjustments should be made based on the patient's clinical condition. Conscious sedation before diagnostic and therapeutic procedures should be approached with caution. Deaths and complications related to conscious sedation therapy have prompted the development of guidelines for safer and more effective pharmacological interven- MYTHS AND MISCONCEPTIONSUntil recently, little attention has been focused on pain management for infants and children. This is primarily related to the myths and misconceptions suggesting that children do not experience pain. For many years, practitioners believed that very young infants did not have the neurological capacity to feel pain, that young children who experience pain did not have memory of such experience, and that children may develop complications, particularly addiction from opioid medications. These beliefs, coupled with the young child's inability to verbalize pain and the caregiver's inability to assess pain in children accurately, have led to misunderstanding of childhood pain and resulted in undertreatment of pain in children. It is evident as one reviews the literature on childhood pain management that there is undoubtedly a discrepancy between pain management in adult and pediatric patients.1-3 For example, postoperative pain management reported for 90 children differs tremendously from that provided to 90 adults with similar diagnoses or who have undergone similar procedures.2 There is a tendency to undertreat children. Less narcotic pain medications are generally ordered for infants and children. Adults received twice the number of narcotic doses per hospital day compared with pediatric patients.2 2 Joumal of Pharmacy Practlce, Vol IX, No 1 (February), tions. The recently published guidelines include recommendations for skilled personnel, continuous monitoring, appropriate use of drugs, and ability to manage unforeseen complications. Selection of the most appropriate sedatives should take into consideration the type of procedure, the patient's clinical condition, and the desired level and duration of consciousness. Similar to pain management, individualization is crucial. This article will discuss the principles of pain management and conscious sedation in children. Facts and scientific findings will be presented to discredit the myths and misconceptions often associated with pediatric pain. Various pain assessment tools will be summarize...

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Anesthetic Agents and Their Cardiovascular Effects

Andropoulos

2005

Anesthesia for Congenital Heart Disease

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Hemodynamic Effects of Ketamine in Children with Congenital Heart Disease

Cited by 34 publications

References 0 publications

Congenital Heart Disease

Congenital Heart Disease

Pain Management and Conscious Sedation for the Pediatric Patient

Anesthetic Agents and Their Cardiovascular Effects

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