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Abstract
Background Little is known about the haemodynamic effects of commonly used paediatric anaesthetic drugs in teenagers. Previous ‘gold-standard’ invasive haemodynamic monitoring is inappropriate in well children, whereas children undergoing haemodynamic monitoring on ICU are not drug-naive.
Aim 6-month study to explore initial haemodynamic effects of commonly used induction agents during elective anaesthesia for orthopaedic conditions in healthy stable children.
Method Consent from those with parental responsibility obtained. All haemodynamic assessment performed using a non-invasive Doppler ultrasound (USCOM). Data collected: stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac index (CI), stroke volume variability (SVV), heart rate (HR) and blood pressure (BP). Times: Immediately prior to induction, then at 10, 20 and 30 min post induction.
Results 9 patients studied – five female; age 11–15 years. Induction agents: Propofol 7; sevoflurane 1; nitrous 1. Descriptive hemodynamics: Propofol – slow and steady fall observed in SV, SVI, CO, CI, SBP, DBP and HR over time. Sevofluorane – same but BP drop more rapid. Nitrous – steady SV, SVI, CO and CI with slow fall in HR but more pronounced fall in BP. No definite pattern could be predicted for SVV.
Conclusion Whilst this data is clearly limited in terms of patient number and variety of agents, it is the first description of the haemodynamic effects of induction of anaesthesia in well children. Whilst there were no deleterious effects, an understanding of the haemodynamic effects of these commonly used agents might lead to safer anaesthesia in more complex and critically ill children.
