Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease

Abstract

Propofol is a short-acting, intravenously administered hypnotic agent which is used in procedural sedation in children. Propofol is known to decrease systemic vascular resistance, arterial blood pressure and can lead to desaturations and decreased systemic perfusion in children with cardiac shunting. This may result in a reduction in cerebral blood flow and oxygenation. Near-infrared spectroscopy (NIRS) can monitor cerebral tissue oxygenation in the frontal neocortex. The objective of our study was to measure the changes in cerebral oxygen and blood supply after Propofol infusion in children with congenital heart disease. Propofol infusion may reduce cerebral oxygenation in children with congenital heart disease. The study group consisted of 32 children (f:m = 18:14), with median age of 49 (5-112) months and median weight of 15 (5-34) kg. We performed NIRS derived continuous measurement of cerebral oxygenation and cardiac output using Electrical velocimetry for 5 min before and after sedation with Propofol (1-2 mg/kg i.v.) for cardiac catheterization. Simultaneously, non-invasive arterial blood pressure and transcutaneous oxygen saturation were measured. Propofol sedation led to a significant decrease in mean arterial pressure (79 ± 16 vs. 67 ± 12 mmHg) (p = 0.01) and cardiac index (3.2 ± 0.8 vs. 2.9 ± 0.6 ml/min/m(2)) (p = 0.03). In contrast, cerebral tissue oxygenation index, increased significantly from 57 ± 11 to 59 ± 10 % (p < 0.05). Sedation with Propofol increased cerebral tissue oxygenation despite a decrease in cardiac index and arterial blood pressure. This may be caused by a decreased oxygen consumption of the sedated brain with intact cerebral auto-regulation.

Near-Infrared Spectroscopy for the Evaluation of Anesthetic Depth

“…This study found that cerebral oxygenation increased and remained stable during the surgery; however no correlation between MAP and rSO 2 could be established [ 51 ]. The elevation in rSO 2 during induction does however support the trends reported by other authors [ 34 , 35 ].…”

“…This study revealed the capacity of fNIRS to measure drug dependent changes in oxygenation associated with anesthetic induction. A similar study on a pediatric population examined the effects of propofol induction on cerebral oxygenation of the frontal cortex [ 35 ]. As in the study by Fleck et al, propofol was found to produce an increase in HbO 2 and HbTot relative to the conscious period [ 35 ].…”

Changes in Near-Infrared Spectroscopy After Congenital Cyanotic Heart Surgery

“…A trend of declining SrO 2 is observed over the first 48 h as the patient recovers from surgery in the PICU. Although we were not able to elicit the exact reasons for this phenomenon in this study, this decreasing trend may be explained by factors that affect CrO 2 and SrO 2 such as increased oxygen demand after surgery as the patient is weaned from sedation and ventilation, low cardiac output states, hypovolemia, microcirculatory disturbance, increased vascular tone, and changes in the toe-core temperature gap ( 5 , 19 , 20 ). However, the lack of decline in CrO 2 values may be related to the preservation of cerebral autoregulation ( 24 , 25 ).…”

“…Patients in this cohort were mostly toddlers and young children who were uncooperative for placement of NIRS sensors prior to anesthesia. Hence, we postulate the high baseline tissue oximetry readings were because the patients were already sedated, intubated, and ventilated, and this may lead to increase in CrO 2 and SrO 2 readings ( 19 , 20 ).…”

Особенности Анестезии У Детей С Гидроцефалией

“…Проте пізніше було доведено, що несприятливі гемодинамічні ефекти препарату можуть бути істотно зменшені, якщо не досягаються високі пікові концентрації анестетика в крові. Ефект пропофолу на церебральне споживання кисню й МК є близьким до такого в барбітуратів [46]. В експерименті на мавпах пропофол викликав дозозалежне зниження МК і споживання кисню при збереженні авторегуляції МК.…”