Choice of Anesthesia Regimen Significantly Impacts Shunting and Diastolic Ventricular Function During Cardiac Catheterization

Abstract

Abstract Background Most pediatric cardiac catheterizations are performed under general anesthesia, but few studies have examined how choice of anesthesia agent impacts hemodynamic data in pediatric patients. Our objective was to compare hemodynamics obtained under inhaled versus total intravenous anesthesia, and to determine if one more closely reflects the awake state. Methods Pediatric patients requiring percutaneous closure of a patent ductus arteriosus (PDA) or surveillance endomyocardial biopsy after orthotopic heart transplant (OHT) at Monroe Carell Jr. Children’s Hospital at Vanderbilt were enrolled. Each participant underwent hemodynamic assessment under inhaled volatile anesthesia (sevoflurane), and then under total intravenous anesthesia (dexmedetomidine and propofol) after a brief washout period. Paired data were analyzed using the Wilcoxon-signed rank test. Linear regression was used to analyze correlation between continuous variables. Results Twenty-five patients (13 OHT, 12 PDA) aged 6 months to 18 years were studied. Compared to baseline pre-procedure non-invasive blood pressure, systolic blood pressure was significantly lower under inhaled anesthesia versus intravenous anesthesia. Systemic vascular resistance was also significantly lower under inhaled anesthesia, while pulmonary vascular resistance was similar in both phases. In patients with a PDA, left-to-right shunting increased significantly under intravenous anesthesia versus inhaled. Similarly, in transplant patients, left ventricular end diastolic pressure (LVEDP) increased following transition to intravenous anesthesia, with a positive correlation between the increase observed and the initial LVEDP under inhaled anesthesia. Conclusions Hemodynamics were impacted by the mechanism of general anesthesia. An intravenous anesthesia regimen may more closely reflect the awake, pre-catheterization state compared to inhaled volatile anesthesia.