Comparative study between the effect of sevoflurane and ketamine-midazolam on the cardiac troponin I level and hemodynamic variables in pediatric therapeutic cardiac catheterization for pulmonic stenosis

ELdeen, Hala M.S.; Messeha, Medhat Mikhail

doi:10.4103/1687-7934.178873

Cited by 2 publications

(1 citation statement)

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“…14 Eldeen and Messeha reported that sevoflurane was a better anesthetic than ketamine and midazolam for children with PS undergoing cardiac catheterization because it caused less myocardial damage and ensured better hemodynamic stability. 15 Also, Rivenes et al demonstrated that the use of sevoflurane at various concentrations-imposed stability of the hemodynamic and cardiac index parameters during cardiac catheterization. 16 In children with ventricular septal defect, Han et al reported an initial increase followed by a quick heart rate and arterial pressure decline with ketamine injection intramuscularly, reflecting significant, adverse variations in hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis

Sayed,

El Moez,

Shoukry

et al. 2023

Anaesth. pain intensive care

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Background & Objective: Congenital pulmonary stenosis (PS) is a prevalent cardiac anomaly that is commonly treated with balloon dilatation. The procedure can be successfully completed under appropriate anesthetic technique, depending upon the choice of the anesthetist and the patients’ physical status. We compared the effect of IV ketamine with sevoflurane inhalational anesthesia on right ventricular pressure in infants undergoing balloon dilatation for congenital pulmonary valve stenosis. Methodology: This double-blinded, randomized, clinical trial included 40 infants, aged from 1 to 12 months, with congenital PS undergoing balloon dilatation. They were randomly allocated to one of the two groups. In the ketamine group, 20 patients received 2 mg/kg of ketamine intravenously till being unconscious. In the sevoflurane group, 20 patients received 3% sevoflurane and were maintained using the open circuit technique till losing consciousness. The right ventricular pressure was the primary outcome. Secondary outcomes were the hemodynamics and oxygen saturation. Results: Compared to sevoflurane, ketamine showed a non-significant difference in the right ventricular pressure before and after induction of anesthesia and after balloon dilatation. The mean arterial blood pressure significantly dropped immediately after sevoflurane induction and after the initial 10 min (P = 0.031 and 0.041, respectively). The heart rate significantly decreased immediately after sevoflurane induction (P = 0.028). The oxygen saturation remained comparable in both groups at 10 and 20 min after induction, and at postoperative anesthesia care unit. Conclusion: Intravenous ketamine is considered a safe and effective alternative to sevoflurane for infants with congenital pulmonary stenosis undergoing balloon dilatation. It maintains the right ventricular pressure with stable hemodynamic effects, compared to sevoflurane inhalational anesthesia. Abbreviations: PS - Pulmonary Stenosis; TS – Tricuspid Stenosis; PACU – Post Anesthesia Care Unit; TTE - Transthoracic Echocardiography Key words: Balloon Dilatation; Infants; Ketamine; Pulmonary Stenosis; Sevoflurane. Citation: Sayed AG, Abd el Moez WA, Shoukry A, Elshafeey AE. Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis. Anaesth. pain intensive care 2023;27(5):451−457; DOI: 10.35975/apic.v27i5.2210 Received: April 18, 2023; Reviewed: July 18, 2023; Accepted: August 21, 2023

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Section: Discussionmentioning

confidence: 99%