title: Alfentanil sedation for cardiac catheterization of children with Fontan shunts.
abstract: After Fontan operation, prolonged invasive cardiac assessment is often needed. This study is a clinical evaluation of the effectiveness of flunitrazepam premedication, EMLA cream, and alfentanil continuous infusion for management of children undergoing such catheterization. Fourteen consecutive subjects aged 5-20 yr with Fontan shunts (right atrium to pulmonary artery) undergoing elective haemodynamic and electrophysiological catheterization were sedated with an individually titrated alfentanil infusion. After oral premedication with flunitrazepam 2 mg, the mean induction dose and mean maintenance requirement of alfentanil were 4.4 +/- 2.7 micrograms.kg-1 and 10.3 +/- 8.6 micrograms.kg-1 x hr-1, respectively. Mean oxygen consumption during haemodynamic catheterization was 4.1 +/- 0.4 ml.kg-1 x min-1 with an average individual variation of 10%. For every patient, tranquil and stable conditions during catheterization could be produced. It is concluded that alfentanil infusion is a method of sedation of children and adolescents with Fontan shunts during haemodynamic and electrophysiologic catheterization. However, continuous monitoring of ventilation and an understanding of the slow circulation time after Fontan operation are essential with such sedation in these patients.
authors.affiliation: Department of Anaesthesiology, Children's Hospital, University of Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Rautiainen
mesh_terms: D000293:Adolescent; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage; D000771:Anesthesia, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage; D016280:Atrial Function, Right; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004338:Drug Combinations; D005445:Flunitrazepam / Q000008:administration & dosage; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D000077442:Lidocaine, Prilocaine Drug Combination; D010101:Oxygen Consumption; D011229:Preanesthetic Medication; D011318:Prilocaine / Q000008:administration & dosage; D011651:Pulmonary Artery / Q000601:surgery; D011669:Pulmonary Wedge Pressure; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D015760:Alfentanil; D005445:Flunitrazepam; D008012:Lidocaine