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Erschienen in: Pediatric Cardiology 3/2015

01.03.2015 | Original Article

Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease

verfasst von: Thilo Fleck, Stephan Schubert, Peter Ewert, Brigitte Stiller, Nicole Nagdyman, Felix Berger

Erschienen in: Pediatric Cardiology | Ausgabe 3/2015

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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/m2) (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.
Literatur
1.
Zurück zum Zitat Bartels SA, Bezemer R, de Vries FJ, Milstein DM, Lima A, Cherpanath TG, van den Meiracker AH, van Bommel J, Heger M, Karemaker JM, Ince C (2011) Multi-site and multi-depth near-infrared spectroscopy in a model of simulated (central) hypovolemia: lower body negative pressure. Intensive Care Med 37:671–677CrossRefPubMedCentralPubMed Bartels SA, Bezemer R, de Vries FJ, Milstein DM, Lima A, Cherpanath TG, van den Meiracker AH, van Bommel J, Heger M, Karemaker JM, Ince C (2011) Multi-site and multi-depth near-infrared spectroscopy in a model of simulated (central) hypovolemia: lower body negative pressure. Intensive Care Med 37:671–677CrossRefPubMedCentralPubMed
2.
Zurück zum Zitat Bilotta F, Fiorani L, La Rosa I, Spinelli F, Rosa G (2001) Cardiovascular effects of intravenous propofol administered at two infusion rates: a transthoracic echocardiographic study. Anaesthesia 56:266–271CrossRefPubMed Bilotta F, Fiorani L, La Rosa I, Spinelli F, Rosa G (2001) Cardiovascular effects of intravenous propofol administered at two infusion rates: a transthoracic echocardiographic study. Anaesthesia 56:266–271CrossRefPubMed
3.
Zurück zum Zitat Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH (2009) The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 108:795–804CrossRefPubMed Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH (2009) The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 108:795–804CrossRefPubMed
4.
Zurück zum Zitat Ebert TJ (2005) Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans. Anesthesiology 103:20–24CrossRefPubMed Ebert TJ (2005) Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans. Anesthesiology 103:20–24CrossRefPubMed
5.
Zurück zum Zitat Fleck T, Schubert S, Redlin M, Stiller B, Ewert P, Berger F, Nagdyman N (2010) Influence of external cardiac pacing on cerebral oxygenation measured by near-infrared spectroscopy in children after cardiac surgery. Paediatr Anaesth 20:553–558CrossRefPubMed Fleck T, Schubert S, Redlin M, Stiller B, Ewert P, Berger F, Nagdyman N (2010) Influence of external cardiac pacing on cerebral oxygenation measured by near-infrared spectroscopy in children after cardiac surgery. Paediatr Anaesth 20:553–558CrossRefPubMed
6.
Zurück zum Zitat Hershenson JA, Ro PS, Miao Y, Tobias JD, Olshove V, Naguib AN (2012) Changes in hemodynamic parameters and cerebral saturation during supraventricular tachycardia. Pediatr Cardiol 33:286–289CrossRefPubMed Hershenson JA, Ro PS, Miao Y, Tobias JD, Olshove V, Naguib AN (2012) Changes in hemodynamic parameters and cerebral saturation during supraventricular tachycardia. Pediatr Cardiol 33:286–289CrossRefPubMed
7.
Zurück zum Zitat Ho CM, Tarng GW, Su CK (2007) Comparison of effects of propofol and midazolam at sedative concentrations on sympathetic tone generation in the isolated spinal cord of neonatal rats. Acta Anaesthesiol Scand 51:708–713CrossRefPubMed Ho CM, Tarng GW, Su CK (2007) Comparison of effects of propofol and midazolam at sedative concentrations on sympathetic tone generation in the isolated spinal cord of neonatal rats. Acta Anaesthesiol Scand 51:708–713CrossRefPubMed
9.
Zurück zum Zitat Laycock GJ, Mitchell IM, Paton RD, Donaghey SF, Logan RW, Morton NS (1992) EEG burst suppression with propofol during cardiopulmonary bypass in children: a study of the haemodynamic, metabolic and endocrine effects. Br J Anaesth 69:356–362CrossRefPubMed Laycock GJ, Mitchell IM, Paton RD, Donaghey SF, Logan RW, Morton NS (1992) EEG burst suppression with propofol during cardiopulmonary bypass in children: a study of the haemodynamic, metabolic and endocrine effects. Br J Anaesth 69:356–362CrossRefPubMed
10.
Zurück zum Zitat Matcher SJ, Kirkpatrick P, Nahid K, Cope M, Delpy DT (1995) Absolute quantification methods in tissue near infrared spectroscopy. Proc SPIE 2389:486–495 Matcher SJ, Kirkpatrick P, Nahid K, Cope M, Delpy DT (1995) Absolute quantification methods in tissue near infrared spectroscopy. Proc SPIE 2389:486–495
11.
Zurück zum Zitat Menke J, Moller G (2014) Cerebral near-infrared spectroscopy correlates to vital parameters during cardiopulmonary bypass surgery in children. Pediatr Cardiol 35:155–163CrossRefPubMed Menke J, Moller G (2014) Cerebral near-infrared spectroscopy correlates to vital parameters during cardiopulmonary bypass surgery in children. Pediatr Cardiol 35:155–163CrossRefPubMed
12.
Zurück zum Zitat Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H (2008) Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth 100:88–94CrossRefPubMed Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H (2008) Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth 100:88–94CrossRefPubMed
13.
Zurück zum Zitat Ono M, Zheng Y, Joshi B, Sigl JC, Hogue CW (2013) Validation of a stand-alone near-infrared spectroscopy system for monitoring cerebral autoregulation during cardiac surgery. Anesth Analg 116:198–204CrossRefPubMedCentralPubMed Ono M, Zheng Y, Joshi B, Sigl JC, Hogue CW (2013) Validation of a stand-alone near-infrared spectroscopy system for monitoring cerebral autoregulation during cardiac surgery. Anesth Analg 116:198–204CrossRefPubMedCentralPubMed
14.
Zurück zum Zitat Park HJ, Kim YL, Kim CS, Kim SD, Kim HS (2007) Changes of bispectral index during recovery from general anesthesia with 2 % propofol and remifentanil in children. Paediatr Anaesth 17:353–357CrossRefPubMed Park HJ, Kim YL, Kim CS, Kim SD, Kim HS (2007) Changes of bispectral index during recovery from general anesthesia with 2 % propofol and remifentanil in children. Paediatr Anaesth 17:353–357CrossRefPubMed
15.
Zurück zum Zitat Petter H, Erik A, Bjorn E, Goran R (2011) Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution. Clin Physiol Funct Imaging 31:39–47CrossRefPubMed Petter H, Erik A, Bjorn E, Goran R (2011) Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution. Clin Physiol Funct Imaging 31:39–47CrossRefPubMed
16.
Zurück zum Zitat Ramaekers VT, Casaer P, Daniels H, Marchal G (1990) Upper limits of brain blood flow autoregulation in stable infants of various conceptional age. Early Hum Dev 24:249–258CrossRefPubMed Ramaekers VT, Casaer P, Daniels H, Marchal G (1990) Upper limits of brain blood flow autoregulation in stable infants of various conceptional age. Early Hum Dev 24:249–258CrossRefPubMed
17.
Zurück zum Zitat Schubert S, Schmitz T, Weiss M, Nagdyman N, Huebler M, Alexi-Meskishvili V, Berger F, Stiller B (2008) Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 22:299–307CrossRefPubMed Schubert S, Schmitz T, Weiss M, Nagdyman N, Huebler M, Alexi-Meskishvili V, Berger F, Stiller B (2008) Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 22:299–307CrossRefPubMed
18.
Zurück zum Zitat Sherry KM, Sartain J, Bell JH, Wilkinson GA (1995) Comparison of the use of a propofol infusion in cardiac surgical patients with normal and low cardiac output states. J Cardiothorac Vasc Anesth 9:368–372CrossRefPubMed Sherry KM, Sartain J, Bell JH, Wilkinson GA (1995) Comparison of the use of a propofol infusion in cardiac surgical patients with normal and low cardiac output states. J Cardiothorac Vasc Anesth 9:368–372CrossRefPubMed
19.
Zurück zum Zitat Soul JS, Taylor GA, Wypij D, Duplessis AJ, Volpe JJ (2000) Noninvasive detection of changes in cerebral blood flow by near-infrared spectroscopy in a piglet model of hydrocephalus. Pediatr Res 48:445–449CrossRefPubMed Soul JS, Taylor GA, Wypij D, Duplessis AJ, Volpe JJ (2000) Noninvasive detection of changes in cerebral blood flow by near-infrared spectroscopy in a piglet model of hydrocephalus. Pediatr Res 48:445–449CrossRefPubMed
20.
Zurück zum Zitat Srinivasan M, Turmelle M, Depalma LM, Mao J, Carlson DW (2012) Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr 160(5):801–806CrossRefPubMed Srinivasan M, Turmelle M, Depalma LM, Mao J, Carlson DW (2012) Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr 160(5):801–806CrossRefPubMed
21.
Zurück zum Zitat Suzuki S, Takasaki S, Ozaki T, Kobayashi Y (1999) A tissue oxygenation monitor using NIR spatially resolved spectroscopy. Proc SPIE 3579:144–145 Suzuki S, Takasaki S, Ozaki T, Kobayashi Y (1999) A tissue oxygenation monitor using NIR spatially resolved spectroscopy. Proc SPIE 3579:144–145
22.
Zurück zum Zitat Tirel O, Wodey E, Harris R, Bansard JY, Ecoffey C, Senhadji L (2008) Variation of bispectral index under TIVA with propofol in a paediatric population. Br J Anaesth 100:82–87CrossRefPubMedCentralPubMed Tirel O, Wodey E, Harris R, Bansard JY, Ecoffey C, Senhadji L (2008) Variation of bispectral index under TIVA with propofol in a paediatric population. Br J Anaesth 100:82–87CrossRefPubMedCentralPubMed
23.
Zurück zum Zitat Tomaske M, Knirsch W, Kretschmar O, Woitzek K, Balmer C, Schmitz A, Bauersfeld U, Weiss M (2008) Cardiac output measurement in children: comparison of Aesculon cardiac output monitor and thermodilution. Br J Anaesth 100:517–520CrossRefPubMed Tomaske M, Knirsch W, Kretschmar O, Woitzek K, Balmer C, Schmitz A, Bauersfeld U, Weiss M (2008) Cardiac output measurement in children: comparison of Aesculon cardiac output monitor and thermodilution. Br J Anaesth 100:517–520CrossRefPubMed
24.
Zurück zum Zitat Tsuji M, duPlessis A, Taylor G, Crocker R, Volpe JJ (1998) Near infrared spectroscopy detects cerebral ischemia during hypotension in piglets. Pediatr Res 44:591–595CrossRefPubMed Tsuji M, duPlessis A, Taylor G, Crocker R, Volpe JJ (1998) Near infrared spectroscopy detects cerebral ischemia during hypotension in piglets. Pediatr Res 44:591–595CrossRefPubMed
25.
Zurück zum Zitat Williams GD, Jones TK, Hanson KA, Morray JP (1999) The hemodynamic effects of propofol in children with congenital heart disease. Anesth Analg 89:1411–1416PubMed Williams GD, Jones TK, Hanson KA, Morray JP (1999) The hemodynamic effects of propofol in children with congenital heart disease. Anesth Analg 89:1411–1416PubMed
Metadaten
Titel
Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease
verfasst von
Thilo Fleck
Stephan Schubert
Peter Ewert
Brigitte Stiller
Nicole Nagdyman
Felix Berger
Publikationsdatum
01.03.2015
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 3/2015
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-014-1047-7

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