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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.

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