Administration of ketamine to children with pulmonary hypertension is safe: pro‐con debate

Williams, Glyn D.; Friesen, Robert H.

doi:10.1111/pan.12033

Cited by 11 publications

(7 citation statements)

References 81 publications

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“… 2 , 21 , 23 – 26 Opioids have a good safety profile and blunt the pulmonary vascular response to noxious stimuli; meanwhile, ketamine may be associated with fewer changes in pulmonary hemodynamics. 23 , 27 – 30 While no specific anesthetic technique is known to be superior, our study suggests that a balanced technique may be safest but this remains an area for further study. 3 , 7 , 8 , 21 …”

Section: Discussionmentioning

confidence: 78%

Perioperative events in children with pulmonary hypertension undergoing non‐cardiac procedures

et al. 2017

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Prior limited research indicates that children with pulmonary hypertension (PH) have higher rates of adverse perioperative outcomes when undergoing non-cardiac procedures and cardiac catheterizations. We examined a single-center retrospective cohort of children with active or pharmacologically controlled PH who underwent cardiac catheterization or non-cardiac surgery during 2006–2014. Preoperative characteristics and perioperative courses were examined to determine relationships between the severity or etiology of PH, type of procedure, and occurrence of major and minor events. We identified 77 patients who underwent 148 procedures at a median age of six months. The most common PH etiologies were bronchopulmonary dysplasia (46.7%), congenital heart disease (29.9%), and congenital diaphragmatic hernia (14.3%). Cardiac catheterizations (39.2%), and abdominal (29.1%) and central venous access (8.9%) were the most common procedures. Major events included failed planned extubation (5.6%), postoperative cardiac arrest (4.7%), induction or intraoperative cardiac arrest (2%), and postoperative death (1.4%). Major events were more frequent in patients with severe baseline PH (P = 0.006) and the incidence was associated with procedure type (P = 0.05). Preoperative inhaled nitric oxide and prostacyclin analog therapies were associated with decreased incidence of minor events (odds ratio [OR] = 0.32, P = 0.046 and OR = 0.24, P = 0.008, respectively), but no change in the incidence of major events. PH etiology was not associated with events (P = 0.24). Children with PH have increased risk of perioperative complications; cardiac arrest and death occur more frequently in patients with severe PH and those undergoing thoracic procedures. Risk may be modified by using preoperative pulmonary vasodilator therapy and lends itself to further prospective studies.

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Section: Discussionmentioning

confidence: 78%

Perioperative events in children with pulmonary hypertension undergoing non‐cardiac procedures

et al. 2017

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“…After pooling data from 7 studies with a total of 139 patients with congenital heart disease and/or pulmonary hypertension, ketamine administration was found to have little impact on hemodynamic and blood gas parameters 2-5 minutes after ketamine administration. [9][10][11][12]14,16 Systemic vascular resistance, pulmonary vascular resistance, systemic arterial pressure, mean pulmonary artery pressure, cardiac index, heart rate, pH, blood oxygen concentration all remained similar after ketamine administration. The blood carbon dioxide concentration did demonstrate a statistically significant increase after ketamine administration although the increase was less than 2 mm Hg, thus not being clinically significant.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Loomba

Gray

Flores

2018

Congenital Heart Disease

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Introduction Ketamine is a drug often used for procedural sedation or as adjunct agent for general sedation in children with congenital heart disease. In the clinical realm, there is often confusion regarding the effects of ketamine on hemodynamics, particularly pulmonary vascular resistance and systemic vascular resistance. We performed a meta‐analysis of studies investigating the effects of ketamine on hemodynamics. Methods A systematic review was conducted to identify studies characterizing the hemodynamic effects of ketamine in children with congenital heart disease. Studies were assessed for quality and those of satisfactory quality with pre‐ and postketamine hemodynamics for each patient were included in the final analyses. Those not limited to pediatric patients and those not limited to patients with congenital heart disease were excluded from the final analyses. Results A total of 7 studies with 139 patients were included in the final analyses. Pulmonary vascular resistance, systemic vascular resistance, mean pulmonary artery pressure, mean systemic pressure, heart rate, pH, and arterial oxygen concentration did not significantly change with administration of ketamine. Carbon dioxide concentration did increase significantly by a mean of 1.38 mm Hg with the administration of ketamine. Conclusion Ketamine has minimal impact on hemodynamics in children with congenital heart disease when used at usual clinical doses. Systemic vascular resistance and pulmonary vascular resistance are not significantly altered. Blood gas values are also only minimally affected by ketamine.

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“…In a retrospective review, there was no statistical significance in complications during catheterizations of PH patients whether ketamine, propofol, etomidate, volatile agent or any combination were used (41). Ketamine has been reported in many studies over the last decade to be safe, despite concerns for increase PVR (40)(41)(42).…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

“…Ketamine has proven successful in pediatric cardiac catheterization . It serves as an anxiolytic, analgesic and sedative‐hypnotic, while preserving airway reflexes and ventilation.…”

Section: Anesthetic Drugsmentioning

confidence: 99%

Anesthesia and the pediatric cardiac catheterization suite: a review

Lam

Lin

Alexy

et al. 2014

Pediatric Anesthesia

111

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Advances in technology over the last couple of decades have caused a shift in pediatric cardiac catheterization from a primary focus on diagnostics to innovative therapeutic interventions. These improvements allow patients a wider range of nonsurgical options for treatment of congenital heart disease. However, these therapeutic modalities can entail higher risk in an already complex patient population, compounded by the added challenges inherent to the environment of the cardiac catheterization suite. Anesthesiologists caring for children with congenital heart disease must understand not only the pathophysiology of the disease but also the effects the anesthetics and interventions have on the patient in order to provide a safe perioperative course. It is the aim of this article to review the latest catheterization modalities offered to patients with congenital heart disease, describe the unique challenges presented in the cardiac catheterization suite, list the most common complications encountered during catheterization and finally, to review the literature regarding different anesthetic drugs used in the catheterization lab.

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Administration of ketamine to children with pulmonary hypertension is safe: pro‐con debate

Cited by 11 publications

References 81 publications

Perioperative events in children with pulmonary hypertension undergoing non‐cardiac procedures

Perioperative events in children with pulmonary hypertension undergoing non‐cardiac procedures

Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Anesthesia and the pediatric cardiac catheterization suite: a review

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