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PEDIATRIC ANESTHESIOLOGY

Fentanyl Added to Propofol Anesthesia Elongates Sinus Node Recovery Time in Pediatric Patients with Paroxysmal Supraventricular Tachycardia

Keisuke Fujii, MD^*, Hiroshi Iranami, MD, PhD^*, Yoshihide Nakamura, MD, PhD, and Yoshio Hatano, MD, PhD

From the *Department of Anesthesiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama City, Wakayama, Japan; Department of Anesthesiology, Wakayama Medical University, Wakayama City, Wakayama, Japan; Department of Pediatric Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama City, Wakayama, Japan; and Department of Anesthesiology, Wakayama Medical University, Wakayama City, Wakayama, Japan.

Address correspondence and reprint requests to Keisuke Fujii, MD, 4-20 Komatsubara-dori, Wakayama City, Wakayama 640-8558, Japan. Address e-mail to fujiik{at}topaz.ocn.ne.jp.

Abstract

BACKGROUND: In some types of pediatric supraventricular tachycardia, reentrant mechanisms are sensitive to enhanced vagal tone. Propofol is a feasible anesthetic for pediatric electrophysiological study and radiofrequency catheter ablation. Although fentanyl and propofol infusions both enhance cardiac vagal tone, it is unclear whether the combination of propofol and fentanyl has a potential to enhance it. In this study, we evaluated the hypothesis that fentanyl combined with propofol could alter cardiac electrophysiological activities in pediatric patients undergoing electrophysiological study and radiofrequency catheter ablation.

METHODS: Twenty-seven pediatric patients (9 Wolff-Parkinson-White syndrome, 7 concealed accessory pathway and 11 atrioventricular nodal reentry tachycardia) were enrolled in this study. Anesthesia was induced with propofol 2.0 mg/kg and was maintained with a continuous infusion of propofol at a rate of 100–167 µg · kg^–1 · min^–1. During a stable anesthetic state, the calculated sinoatrial conduction time and corrected sinus node recovery time (CSNRT) were measured before and after fentanyl administration. The fentanyl dose consisted of an initial 2.0 µg/kg IV bolus and subsequent continuous infusion of 0.075 µg · kg^–1 · min^–1.

RESULTS: Bispectral Index scores and systemic blood pressure remained unchanged throughout the examinations. Fentanyl administration significantly prolonged CSNRT (P = 0.005) but not calculated sinoatrial conduction time (P = 0.35).

CONCLUSION: Since an enhanced cardiac vagal tone is one of the causative factors for prolonged CSNRT, our findings greatly support the hypothesis that fentanyl combined with propofol has a potential to enhance cardiac vagal tone.