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Anesteziologiia i reanimatologiia

[Use of sevoflurane during cardiosurgical and endovascular operations in children].


PMID 17184054

Abstract

The good tolerability of sevoflurane, the mild and prompt onset of a hypnotic state, the absence of airway irritation, and the safe use of the agent make the anesthetic of choice for introductory anesthesia in pediatric cardiosurgery. The purpose of the study was to develop and assess the procedure of sevoflurane anesthesia during cardiosurgical and endovascular operations in children with congenital heart diseases. Twenty-five children aged 2-9 years (of them 15 children with congenital heart disease) operated on under extracorporeal circulation (EC) were examined. Ten children underwent X-ray surgical endovascular interventions: closure of the patent arterial duct with an "Amplatzer ductus occluder" system. The duration of operations under EC was 116 to 289 min; that of EC was 60-20 (49 +/- 8) min. Endovascular operations lasted 60-80 min. Premedication was made with ketamine, midazolam, and methacin during cardiosurgical operations. The children were referred without premedication, escorted by their parents for endovascular surgical interventions where in the parents' presence the children were given inhalational sevoflurane at a concentration of 5-6% through the mask of an anesthetic apparatus until they fell asleep. This made it possible to avoid the child's weeping and resistance and to puncture the peripheral vein without pain. Steady-state hemodynamics and metabolism suggest that combined anesthesia using sevoflurane at a concentration of 1.3-22% of the minimal alveolar one is adequate in correcting congenital heart disease in children. The application of this anesthetic procedure permitted extubation of 73% of children within 1-2 hours when their condition met the criteria for early activation and extubation.