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PEDIATRIC ANESTHESIA

Hemodynamic Responses to Etomidate on Induction of Anesthesia in Pediatric Patients

Molly Sarkar, MD, PhD^*, Peter C. Laussen, MBBS^*, David Zurakowski, PhD, Avinash Shukla, MD^*, Barry Kussman, MBBS^*, and Kirsten C. Odegard, MD^*

Departments of *Anesthesia and Orthopaedic Surgery, Children’s Hospital, Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Kirsten C. Odegard, MD, Cardiac Anesthesia Service, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. Address electronic mail to: kirsten.odegard{at}childrens.harvard.edu.

Etomidate is often used for inducing anesthesia in patients who have limited hemodynamic reserve. Using invasive hemodynamic monitoring, we studied the acute effects of a bolus of etomidate during induction of anesthesia in children. Twelve children undergoing cardiac catheterization were studied (mean age, 9.2 ± 4.8 yr; mean weight, 33.4 ± 15.4 kg); catheterization procedures included device closure of secundum atrial septal defects (n = 7) and radiofrequency catheter ablation procedures for supraventricular tachycardia (n = 5). Using IV sedation, a balloon-tipped pulmonary artery catheter was placed to measure intracardiac and pulmonary artery pressures and oxygen saturations. Baseline measurements were recorded and then re-peated after a bolus of IV etomidate (0.3 mg/kg). For the entire group, no significant changes in right atrial, aortic, or pulmonary artery pressure, oxygen saturations, calculated Qp:Qs ratio or systemic or pulmonary vascular resistance were detected after the bolus dose of etomidate. The lack of clinically significant hemodynamic changes after etomidate administration supports the clinical impression that etomidate is safe in children. Further research is needed to determine the hemodynamic profile of etomidate in neonates and in pediatric patients with severe ventricular dysfunction and pulmonary hypertension.

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