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PEDIATRIC ANESTHESIA

The Safety and Efficacy of Sevoflurane Anesthesia in Infants and Children with Congenital Heart Disease

Isobel A. Russell, MD, PhD^*, Wanda C. Miller Hance, MD^*, George Gregory, MD^*, Michel C. Balea, MS^*, Lydia Cassorla, MD^*, Anil DeSilva, MD^*, Robert F. Hickey, MD^*, Lynne M. Reynolds, MD^*, Kathryn Rouine-Rapp, MD^*, Frank L. Hanley, MD, V. Mohan Reddy, MD, and Michael K. Cahalan, MD^*

Departments of *Anesthesia and Perioperative Care and Surgery, Division of Pediatric Cardiac Surgery, University of California, San Francisco, California

Address correspondence to Isobel A. Russell, MD, PhD, Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Ave., C450, San Francisco, CA 94143-0648.

We tested the hypothesis that sevoflurane is a safer and more effective anesthetic than halothane during the induction and maintenance of anesthesia for infants and children with congenital heart disease undergoing cardiac surgery. With a background of fentanyl (5 µg/kg bolus, then 5 µg · kg^-1 · h^-1), the two inhaled anesthetics were directly compared in a randomized, double-blinded, open-label study involving 180 infants and children. Primary outcome variables included severe hypotension, bradycardia, and oxygen desaturation, defined as a 30% decrease in the resting mean arterial blood pressure or heart rate, or a 20% decrease in the resting arterial oxygen saturation, for at least 30 s. There were no differences in the incidence of these variables; however, patients receiving halothane experienced twice as many episodes of severe hypotension as those who received sevoflurane (P = 0.03). These recurrences of hypotension occurred despite an increased incidence of vasopressor use in the halothane-treated patients than in the sevoflurane-treated patients. Multivariate stepwise logistic regression demonstrated that patients less than 1 yr old were at increased risk for hypotension compared with older children (P = 0.0004), and patients with preoperative cyanosis were at increased risk for developing severe desaturation (P = 0.049). Sevoflurane may have hemodynamic advantages over halothane in infants and children with congenital heart disease.

Implications: In infants and children with congenital heart disease, anesthesia with sevoflurane may result in fewer episodes of severe hypotension and less emergent drug use than anesthesia with halothane.

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