Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease - An echocardiographic study of myocardial contractility and hemodynamics
Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease - An echocardiographic study of myocardial contractility and hemodynamics
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DOI：
10.1097/00000542-200102000-00010
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发表时间：
2001-02-01
期刊：
影响因子：
8.8
通讯作者：
Andropoulos, DB
中科院分区：
文献类型：
--
作者：
Rivenes, SM;Lewin, MB;Andropoulos, DB
背景资料：卤化麻醉剂对心脏正常儿童的心血管效应已有研究，但对心脏病儿童的数据有限。本研究比较了氟烷、异氟烷、七氟烷和芬太尼-咪达唑仑对先天性心脏病患者全身和肺血流动力学及心肌收缩力的影响。54例年龄小于14岁的先天性心脏病手术患者随机接受氟烷、七氟烷、异氟烷或芬太尼-咪达唑仑，在基线和随机排序的1和1.5最小肺泡浓度或预测等效芬太尼-咪达唑仑血浆浓度时记录心血管和超声心动图数据。计算短轴缩短分数和射血分数（使用改良的Simpson规则）。心脏指数进行了评估的velocity-time integral method.Results：氟烷引起的平均动脉压，射血分数，心脏指数显着下降，只保留在基线水平的心率，芬太尼-咪达唑仑组合引起的心脏指数显着下降继发于心率下降;收缩力得到维持。七氟烷可维持心脏指数和心率，并且与氟烷相比，其舒张和负性肌力作用较弱。异氟烷保存心脏指数和射血分数，平均动脉压抑制比氟烷，并增加heartrate.Conclusions：异氟烷和七氟烷保存心脏指数，异氟烷和芬太尼-咪达唑仑保存心肌收缩力在这组先天性心脏病患者的基线水平。氟烷降低心脏指数和心肌收缩力。
Background: The cardiovascular effects of halogenated anesthetic agents in children with normal hearts have been studied, but data in children with cardiac disease are Limited. This study compared the effects of halothane, isoflurane, sevoflurane, and fentanyl-midazolam on systemic and pulmonary hemodynamics and myocardial contractility in patients with congenital heart disease.Methods: Fifty-four patients younger than age 14 scheduled to undergo congenital heart surgery were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl-midazolam, Cardiovascular and echocardiographic data were recorded at baseline and at randomly ordered 1 and 1.5 minimum alveolar concentrations, or predicted equivalent fentanyl-midazolam plasma concentrations. The shortening fraction and ejection fraction (using the modified Simpson rule) were calculated. Cardiac index was assessed by the velocity-time integral method.Results: Halothane caused a significant decrease in mean arterial pressure, ejection fraction, and cardiac index, preserving only heart rate at baseline levels, Fentanyl-midazolam in combination caused a significant decrease in cardiac index secondary to a decrease in heart rate; contractility was maintained. Sevoflurane maintained cardiac index and heart rate and had less profound hypotensive and negative inotropic effects than halothane. Isoflurane preserved both cardiac index and ejection fraction, had less suppression of mean arterial pressure than halothane, and increased heart rate.Conclusions: Isoflurane and sevoflurane preserved cardiac index, and isoflurane and fentanyl-midazolam preserved myocardial contractility at baseline levels in this group of patients with congenital heart disease. Halothane depressed cardiac index and myocardial contractility.