Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study

Background Neonates and infants with congenital heart disease undergoing general anesthesia have an increased risk for critical cardiovascular events. Etomidate produces very minimal changes in hemodynamic parameters in older children with congenital heart disease. There is a lack of studies evaluat...

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Veröffentlicht in:Pediatric anesthesia 2020-09, Vol.30 (9), p.984-989
Hauptverfasser: Dennhardt, Nils, Elfgen‐Schiffner, Frederike‐Debora, Keil, Oliver, Beck, Christiane E., Heiderich, Sebastian, Sümpelmann, Robert, Nickel, Katja
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container_end_page 989
container_issue 9
container_start_page 984
container_title Pediatric anesthesia
container_volume 30
creator Dennhardt, Nils
Elfgen‐Schiffner, Frederike‐Debora
Keil, Oliver
Beck, Christiane E.
Heiderich, Sebastian
Sümpelmann, Robert
Nickel, Katja
description Background Neonates and infants with congenital heart disease undergoing general anesthesia have an increased risk for critical cardiovascular events. Etomidate produces very minimal changes in hemodynamic parameters in older children with congenital heart disease. There is a lack of studies evaluating the effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease. Aim The aim of this prospective observational study was to evaluate the effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease. Methods In fifty infants aged 0‐11 months (24% neonates n = 12) with congenital heart disease, mean arterial blood pressure, cardiac index using electrical cardiometry, and regional cerebral oxygen saturation using near‐infrared spectroscopy were measured at baseline and 1, 3, 5, and 10 minutes after induction by 0.4 mg kg−1 etomidate. Hypotension was defined as a mean arterial blood pressure under 35 mm Hg and cerebral desaturation as a regional cerebral oxygen saturation of less than 80% of baseline. Results Mean arterial blood pressure, cardiac index, and regional cerebral oxygen saturation remained stable above the predefined limits. Mean arterial blood pressure decreased slightly within a physiological range after 3 minutes (P = .005, 95% CI:‐5.9 to −1.0). No significant change in cardiac index could be observed. Conclusion Etomidate 0.4mg kg−1 does not impair systemic or regional cerebral perfusion in neonates or infants with congenital heart disease.
doi_str_mv 10.1111/pan.13977
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Etomidate produces very minimal changes in hemodynamic parameters in older children with congenital heart disease. There is a lack of studies evaluating the effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease. Aim The aim of this prospective observational study was to evaluate the effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease. Methods In fifty infants aged 0‐11 months (24% neonates n = 12) with congenital heart disease, mean arterial blood pressure, cardiac index using electrical cardiometry, and regional cerebral oxygen saturation using near‐infrared spectroscopy were measured at baseline and 1, 3, 5, and 10 minutes after induction by 0.4 mg kg−1 etomidate. Hypotension was defined as a mean arterial blood pressure under 35 mm Hg and cerebral desaturation as a regional cerebral oxygen saturation of less than 80% of baseline. Results Mean arterial blood pressure, cardiac index, and regional cerebral oxygen saturation remained stable above the predefined limits. Mean arterial blood pressure decreased slightly within a physiological range after 3 minutes (P = .005, 95% CI:‐5.9 to −1.0). No significant change in cardiac index could be observed. 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Etomidate produces very minimal changes in hemodynamic parameters in older children with congenital heart disease. There is a lack of studies evaluating the effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease. Aim The aim of this prospective observational study was to evaluate the effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease. Methods In fifty infants aged 0‐11 months (24% neonates n = 12) with congenital heart disease, mean arterial blood pressure, cardiac index using electrical cardiometry, and regional cerebral oxygen saturation using near‐infrared spectroscopy were measured at baseline and 1, 3, 5, and 10 minutes after induction by 0.4 mg kg−1 etomidate. Hypotension was defined as a mean arterial blood pressure under 35 mm Hg and cerebral desaturation as a regional cerebral oxygen saturation of less than 80% of baseline. Results Mean arterial blood pressure, cardiac index, and regional cerebral oxygen saturation remained stable above the predefined limits. Mean arterial blood pressure decreased slightly within a physiological range after 3 minutes (P = .005, 95% CI:‐5.9 to −1.0). No significant change in cardiac index could be observed. 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Results Mean arterial blood pressure, cardiac index, and regional cerebral oxygen saturation remained stable above the predefined limits. Mean arterial blood pressure decreased slightly within a physiological range after 3 minutes (P = .005, 95% CI:‐5.9 to −1.0). No significant change in cardiac index could be observed. Conclusion Etomidate 0.4mg kg−1 does not impair systemic or regional cerebral perfusion in neonates or infants with congenital heart disease.</abstract><cop>France</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32767521</pmid><doi>10.1111/pan.13977</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-7179-0084</orcidid><orcidid>https://orcid.org/0000-0002-5742-5558</orcidid><orcidid>https://orcid.org/0000-0003-3831-1608</orcidid><orcidid>https://orcid.org/0000-0001-5850-7443</orcidid><oa>free_for_read</oa></addata></record>
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subjects Blood pressure
cardiac index
Cardiovascular disease
Congenital diseases
congenital heart disease
etomidate
Heart
infants
neonates
Observational studies
Oxygen saturation
perfusion
title Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study
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