Comparison of the hemodynamic and echocardiographic effects of sufentanil, fentanyl, isoflurane, and halothane for pediatric cardiovascular surgery.
Comparison of the hemodynamic and echocardiographic effects of sufentanil, fentanyl, isoflurane, and halothane for pediatric cardiovascular surgery.
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DOI：
10.1016/0888-6296(88)90264-5
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发表时间：
1988-04-01
期刊：
影响因子：
--
通讯作者：
Henry, D B
中科院分区：
文献类型：
--
作者：
Glenski, J A;Friesen, R H;Henry, D B
在48例接受先天性心脏病修补术的6个月至9岁的婴儿和儿童中，比较了舒芬太尼、芬太尼、氟烷和异氟烷作为唯一麻醉剂的效果。患者被随机分配接受舒芬太尼，20微克/公斤，芬太尼，100微克/公斤，异氟烷，1.6%，或氟烷，0.9%，沿着与泮库溴铵，0.08毫克/公斤，诱导和维持麻醉。在诱导前、诱导后和插管后通过超声心动图测量心血管功能。同时记录全身动脉压和心率。每种药物诱导后左心室射血分数（LVEF）均降低：舒芬太尼9%、芬太尼9%、异氟烷4%和氟烷8%。插管后，舒芬太尼、芬太尼和异氟烷组的LVEF增加，但氟烷组的LVEF仍低于基线值13%。氟烷组12例患者中有5例LVEF低于55%。每组中，旁路术前即刻的动脉压显著低于基线;然而，在大血管隔离和插管期间，麻醉组的动脉压较高。结论是，氟烷，0.9%，作为一种诱导剂，在婴儿和儿童接受心脏手术的原因，在LVEF的临床显着下降。根据超声心动图数据，本研究中使用的舒芬太尼、芬太尼和异氟烷对心脏功能没有临床显着影响，并且可能为心血管储备不足的婴儿和儿童提供优势。
Sufentanil, fentanyl, halothane, and isoflurane were compared as sole anesthetic agents in 48 infants and children aged 6 months to 9 years, undergoing repair of congenital heart defects. Patients were randomly assigned to receive sufentanil, 20 microg/kg, fentanyl, 100 microg/kg, isoflurane, 1.6%, or halothane, 0.9%, along with pancuronium, 0.08 mg/kg, for induction and maintenance of anesthesia. Cardiovascular function was measured by echocardiography prior to induction, postinduction, and postintubation. Systemic arterial pressure and heart rate were also recorded. Left ventricular ejection fraction (LVEF) decreased following induction with each agent: sufentanil 9%, fentanyl 9%, isoflurane 4%, and halothane 8%. Following intubation LVEF increased in the sufentanil, fentanyl, and isoflurane groups, but LVEF remained 13% below baseline values in the halothane group. Five of the 12 patients in the halothane group had a LVEF less than 55%. Arterial pressure immediately prior to bypass was significantly less than baseline in each group; however, arterial pressure was higher in the narcotic groups during isolation and cannulation of the great vessels. It is concluded that halothane, 0.9%, used as an induction agent in infants and children undergoing cardiac surgery causes a clinically significant decrease in LVEF. Based on the echocardiographic data, sufentanil, fentanyl, and isoflurane as used in the present study do not have a clinically significant effect on cardiac function and may offer an advantage to infants and children with marginal cardiovascular reserve.