JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (28) Citing Articles via Google Scholar Google Scholar Articles by Williams, G. D. Articles by Morray, J. P. Search for Related Content PubMed PubMed Citation Articles by Williams, G. D. Articles by Morray, J. P.

---

PEDIATRIC ANESTHESIA

The Hemodynamic Effects of Propofol in Children with Congenital Heart Disease

Glyn D. Williams, FFA(SA)^*, Thomas K. Jones, MD, Kimberly A. Hanson, MD, PhD^*, and Jeffrey P. Morray, MD^*

Departments of *Anesthesiology and Pediatrics, University of Washington School of Medicine and Children’s Hospital and Regional Medical Center, Seattle, Washington

Address correspondence to Glyn D. Williams, Department of Anesthesia and Critical Care, Children’s Hospital and Medical Center, 4800 Sand Point Way NE, P.O. Box C5371, Seattle, WA 98105.

We studied the hemodynamic effects of propofol during elective cardiac catheterization in 30 children with congenital heart disease. Sixteen patients were without cardiac shunt (Group I), six had left-to-right cardiac shunt (Group II), and eight had right-to-left cardiac shunt (Group III). The mean (±SD) ages were 3.8 ± 3.1 yr (Group I), 3.2 ± 3.7 yr (Group II), and 1.0 ± 0.6 yr (Group III). After sedation and cardiac catheter insertion, hemodynamic data and oxygen consumption were measured before and after the administration of propofol (2-mg/kg bolus, 50- to 200-µg · kg^-1 · min^-1 infusion), and values were compared by using a paired t-test (significance: P < 0.05). After the propofol administration, systemic mean arterial pressure and systemic vascular resistance decreased significantly and systemic blood flow increased significantly in all patient groups; heart rate, pulmonary mean arterial pressure, and pulmonary vascular resistance were unchanged. Pulmonary to systemic resistance ratio increased (Group I, P = 0.005; Group II, P = 0.03; Group III, P = 0.10). In patients with cardiac shunt, propofol resulted in decreased left-to-right flow and increased right-to-left flow; the pulmonary to systemic flow ratio decreased significantly (Group II, P = 0.005; Group III, P = 0.01). Clinically relevant decreases in PaO₂ (P = 0.008) and SaO₂ (P = 0.01) occurred in Group III patients. We conclude that propofol can result in clinically important changes in cardiac shunt direction and flow.

Implications: The principal hemodynamic effect of propofol in children with congenital heart defects is a decrease in systemic vascular resistance. In children with cardiac shunt, this results in a decrease in the ratio of pulmonary to systemic blood flow, and it can lead to arterial desaturation in patients with cyanotic heart disease.

This article has been cited by other articles:

				P. Papoff, M. Mancuso, E. Caresta, and C. Moretti Effectiveness and Safety of Propofol in Newborn Infants Pediatrics, February 1, 2008; 121(2): 448 - 448. [Full Text] [PDF]

				G. D. Williams, B. M. Philip, L. F. Chu, M. G. Boltz, K. Kamra, H. Terwey, G. B. Hammer, S. B. Perry, J. A. Feinstein, and C. Ramamoorthy Ketamine Does Not Increase Pulmonary Vascular Resistance in Children with Pulmonary Hypertension Undergoing Sevoflurane Anesthesia and Spontaneous Ventilation Anesth. Analg., December 1, 2007; 105(6): 1578 - 1584. [Abstract] [Full Text] [PDF]

				M. J. Carmosino, R. H. Friesen, A. Doran, and D. D. Ivy Perioperative Complications in Children with Pulmonary Hypertension Undergoing Noncardiac Surgery or Cardiac Catheterization Anesth. Analg., March 1, 2007; 104(3): 521 - 527. [Abstract] [Full Text] [PDF]

				K. M. Bailey, E. A. Gottlieb, J. L. Edmonds Jr, and W. C. Miller-Hance Anesthetic Management of a Young Adult with Complex Congenital Heart Disease and Bronchopleural Fistula for Rigid Bronchoscopy Anesth. Analg., December 1, 2006; 103(6): 1432 - 1435. [Abstract] [Full Text] [PDF]

				P. Goyal, U. Kiran, S. Chauhan, R. Juneja, and M. Choudhary Efficacy of nitroglycerin inhalation in reducing pulmonary arterial hypertension in children with congenital heart disease Br. J. Anaesth., August 1, 2006; 97(2): 208 - 214. [Abstract] [Full Text] [PDF]

				R. Yumul, A. Emdadi, and N. Moradi Anesthesia for Noncardiac Surgery in Children with Congenital Heart Disease Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2003; 7(2): 153 - 165. [Abstract] [PDF]

				K. N Hofer, M. W McCarthy, M. L Buck, and A. E Hendrick Possible Anaphylaxis after Propofol in a Child with Food Allergy Ann. Pharmacother., March 1, 2003; 37(3): 398 - 401. [Abstract] [Full Text] [PDF]

				D. N. Cornfield, K. Tegtmeyer, M. D. Nelson, C. E. Milla, and M. Sweeney Continuous Propofol Infusion in 142 Critically Ill Children Pediatrics, December 1, 2002; 110(6): 1177 - 1181. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999