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 |
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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 |
format | Article |
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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.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.13977</identifier><identifier>PMID: 32767521</identifier><language>eng</language><publisher>France: Wiley Subscription Services, Inc</publisher><subject>Blood pressure ; cardiac index ; Cardiovascular disease ; Congenital diseases ; congenital heart disease ; etomidate ; Heart ; infants ; neonates ; Observational studies ; Oxygen saturation ; perfusion</subject><ispartof>Pediatric anesthesia, 2020-09, Vol.30 (9), p.984-989</ispartof><rights>2020 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd</rights><rights>2020 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-e85a6a2974c44b785975d4d184ca9c4a1cf1d71252cf2a760a42b2bf086bffe63</citedby><cites>FETCH-LOGICAL-c3537-e85a6a2974c44b785975d4d184ca9c4a1cf1d71252cf2a760a42b2bf086bffe63</cites><orcidid>0000-0002-7179-0084 ; 0000-0002-5742-5558 ; 0000-0003-3831-1608 ; 0000-0001-5850-7443</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.13977$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.13977$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32767521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dennhardt, Nils</creatorcontrib><creatorcontrib>Elfgen‐Schiffner, Frederike‐Debora</creatorcontrib><creatorcontrib>Keil, Oliver</creatorcontrib><creatorcontrib>Beck, Christiane E.</creatorcontrib><creatorcontrib>Heiderich, Sebastian</creatorcontrib><creatorcontrib>Sümpelmann, Robert</creatorcontrib><creatorcontrib>Nickel, Katja</creatorcontrib><title>Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><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.</description><subject>Blood pressure</subject><subject>cardiac index</subject><subject>Cardiovascular disease</subject><subject>Congenital diseases</subject><subject>congenital heart disease</subject><subject>etomidate</subject><subject>Heart</subject><subject>infants</subject><subject>neonates</subject><subject>Observational studies</subject><subject>Oxygen saturation</subject><subject>perfusion</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp1kctu1TAQhi0EoqWw4AWQJTZlkdZ2fEnYHVUFKlXAAtaR44xbV4kTbKfVeRMel2lTWFTCG4_Gn_-5_IS85eyE4zldbDzhdWvMM3LIpWZVq1rxHGOuVKW0VAfkVc43jPFaaPGSHNTCaKMEPyS_z70HV-jsKZR5CoMtQOdI8z4XmIKjNg40wVWYox2pgwR9wmCB5NeMSRoijYCPBfIDG6K3sWR6F8o1dXO8ghgK_rgGmwodQgab4SPd0SXNecHS4RYL9hnSrS1blVzWYf-avPB2zPDm8T4iPz-d_zj7Ul1--3xxtrusXK1qU0GjrLaiNdJJ2ZtGtUYNcuCNdLZ10nLn-WC4UMJ5YY1mVope9J41usfJdX1Ejjdd7OfXCrl0U8gOxtHiWGvuhKx5g1sTDNH3T9CbeU3Y8T0lNS6btQKpDxvlcMCcwHdLCpNN-46z7t6uDu3qHuxC9t2j4tpPMPwj__qDwOkG3IUR9v9X6r7vvm6SfwBGpqF3</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Dennhardt, Nils</creator><creator>Elfgen‐Schiffner, Frederike‐Debora</creator><creator>Keil, Oliver</creator><creator>Beck, Christiane E.</creator><creator>Heiderich, Sebastian</creator><creator>Sümpelmann, Robert</creator><creator>Nickel, Katja</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><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></search><sort><creationdate>202009</creationdate><title>Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study</title><author>Dennhardt, Nils ; Elfgen‐Schiffner, Frederike‐Debora ; Keil, Oliver ; Beck, Christiane E. ; Heiderich, Sebastian ; Sümpelmann, Robert ; Nickel, Katja</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-e85a6a2974c44b785975d4d184ca9c4a1cf1d71252cf2a760a42b2bf086bffe63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Blood pressure</topic><topic>cardiac index</topic><topic>Cardiovascular disease</topic><topic>Congenital diseases</topic><topic>congenital heart disease</topic><topic>etomidate</topic><topic>Heart</topic><topic>infants</topic><topic>neonates</topic><topic>Observational studies</topic><topic>Oxygen saturation</topic><topic>perfusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dennhardt, Nils</creatorcontrib><creatorcontrib>Elfgen‐Schiffner, Frederike‐Debora</creatorcontrib><creatorcontrib>Keil, Oliver</creatorcontrib><creatorcontrib>Beck, Christiane E.</creatorcontrib><creatorcontrib>Heiderich, Sebastian</creatorcontrib><creatorcontrib>Sümpelmann, Robert</creatorcontrib><creatorcontrib>Nickel, Katja</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dennhardt, Nils</au><au>Elfgen‐Schiffner, Frederike‐Debora</au><au>Keil, Oliver</au><au>Beck, Christiane E.</au><au>Heiderich, Sebastian</au><au>Sümpelmann, Robert</au><au>Nickel, Katja</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2020-09</date><risdate>2020</risdate><volume>30</volume><issue>9</issue><spage>984</spage><epage>989</epage><pages>984-989</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>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.</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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