Background: Conduct of stable inhalational anesthetic induction in children with congenital heart disease (CHD) presents special challenges. It requires in-depth understanding of the effect of congenital shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs. Intracardiac shunts can alter the induction time and if delivery of anesthetic agent is not carefully titrated, can lead to overdosing and undesirable myocardial depression.
Aims: To study the effect of congenital shunt lesions on the speed of inhalational induction and also the impact of inhalational induction on hemodynamics in the presence of congenital shunt lesions.
Setting: Tertiary care hospital.
Design: A prospective, single-center clinical study.
Materials And Methods: Ninety-three pediatric patients undergoing elective surgery were segregated into three equal groups, namely, Group 1: no CHD, Group 2: acyanotic CHD, and Group 3: cyanotic CHD. General anesthesia was induced with 8% sevoflurane in 6 L/min air-oxygen. The time to induction was noted at loss of eyelash reflex and decrease in bispectral index (BIS) value below 60. End-tidal sevoflurane concentration, minimum alveolar concentration, and BIS were recorded at 15 s intervals for the 1 st min followed by 30 s interval for another 1 min during induction. Hemodynamic data were recorded before and after induction.
Results: Patients in Group 3 had significantly prolonged induction time (99 ± 12.3 s; P < 0.001), almost twice that of the patients in other two groups (51 ± 11.3 s in Group 1 and 53 ± 12.0 s in Group 2). Hypotension occurred after induction in Group 1. No other adverse hemodynamic perturbations were observed.
Conclusion: The time to inhalational induction of anesthesia is significantly prolonged in patients with right-to-left shunt, compared to patients without CHD or those with left-to-right shunt, in whom it is similar. Sevoflurane is safe and maintains stable hemodynamics in the presence of CHD.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971975 | PMC |
| http://dx.doi.org/10.4103/0971-9784.185531 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
High-flow nasal cannula for pre- and apneic oxygenation during rapid sequence induction intubation in emergency surgery: A systematic review and meta-analysis.
PLoS One
January 2025
Department of Anesthesiology, The Second Affiliated Hospital, The Army Military Medical University, Chongqing, China.
Background: Rapid sequence induction intubation (RSII) is commonly used in emergency surgeries for patients at high risk of aspiration. However, these patients are more susceptible to hypoxemia during the RSII process. High-flow nasal cannula (HFNC) oxygen therapy has emerged as a potential alternative to traditional face mask (FM) ventilation pre- and apneic oxygenation.
View Article and Find Full Text PDFIntegrative assessment of mixture toxicity of household chemicals using the toxic unit approach and mode of action.
Toxicology
January 2025
College of Pharmacy, Kyungsung University, Busan 48434, Republic of Korea. Electronic address:
Household chemicals used daily are often combined, leading to inhalation exposure to mixtures. However, methods for assessing their toxic effects are limited. This study proposes an in vitro assay strategy for evaluating household chemical mixtures using benzalkonium chloride (BKC) and didecyldimethylammonium chloride (DDAC), a common disinfectant.
View Article and Find Full Text PDFPro-inflammatory effects of inhaled Great Salt Lake dust particles.
Part Fibre Toxicol
January 2025
Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S. 2000 E., Room 201 Skaggs Hall, Salt Lake City, UT, 84112, USA.
Background: Climate change and human activities have caused the drying of marine environments around the world. An example is the Great Salt Lake in Utah, USA which is at a near record low water level. Adverse health effects have been associated with exposure to windblown dust originating from dried lakebed sediments, but mechanistic studies evaluating the health effects of these dusts are limited.
View Article and Find Full Text PDFSilica-exposed patients with silicosis show shorter telomeres than do unexposed individuals: a pilot study in a population in southeastern Brazil.
J Bras Pneumol
January 2025
. Departamento de Biologia Geral, Universidade Federal Fluminense, Niterói (RJ) Brasil.
Objective: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by the inhalation of silica particles. Silica dust inhalation is associated with inflammation and induction of oxidative stress in the lungs. This oxidative stress affects telomeres, which are short tandem DNA repeats that cap the end of linear chromosomes.
View Article and Find Full Text PDFThe kinetically-derived maximal dose (KMD) is defined as the maximum external dose at which kinetics are unchanged relative to lower doses, e.g., doses at which kinetic processes are not saturated.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!