title: Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease: an echocardiographic study of myocardial contractility and hemodynamics.
abstract: BACKGROUND
  The cardiovascular effects of halogenated anesthetic agents in children with normal hearts have been studied, but data in children with cardiac disease are limited. This study compared the effects of halothane, isoflurane, sevoflurane, and fentanyl-midazolam on systemic and pulmonary hemodynamics and myocardial contractility in patients with congenital heart disease.
  
  
  METHODS
  Fifty-four patients younger than age 14 scheduled to undergo congenital heart surgery were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl-midazolam. Cardiovascular and echocardiographic data were recorded at baseline and at randomly ordered 1 and 1.5 minimum alveolar concentrations, or predicted equivalent fentanyl-midazolam plasma concentrations. The shortening fraction and ejection fraction (using the modified Simpson rule) were calculated. Cardiac index was assessed by the velocity-time integral method.
  
  
  RESULTS
  Halothane caused a significant decrease in mean arterial pressure, ejection fraction, and cardiac index, preserving only heart rate at baseline levels. Fentanyl-midazolam in combination caused a significant decrease in cardiac index secondary to a decrease in heart rate; contractility was maintained. Sevoflurane maintained cardiac index and heart rate and had less profound hypotensive and negative inotropic effects than halothane. Isoflurane preserved both cardiac index and ejection fraction, had less suppression of mean arterial pressure than halothane, and increased heart rate.
  
  
  CONCLUSIONS
  Isoflurane and sevoflurane preserved cardiac index, and isoflurane and fentanyl-midazolam preserved myocardial contractility at baseline levels in this group of patients with congenital heart disease. Halothane depressed cardiac index and myocardial contractility.
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Rivenes
authors.forename: M B
authors.initials: MB
authors.lastname: Lewin
authors.forename: S A
authors.initials: SA
authors.lastname: Stayer
authors.forename: S T
authors.initials: ST
authors.lastname: Bent
authors.forename: H M
authors.initials: HM
authors.lastname: Schoenig
authors.forename: E D
authors.initials: ED
authors.lastname: McKenzie
authors.forename: C D
authors.initials: CD
authors.lastname: Fraser
authors.forename: D B
authors.initials: DB
authors.lastname: Andropoulos
mesh_terms: D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006221:Halothane / Q000494:pharmacology; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007530:Isoflurane / Q000494:pharmacology; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology; D008874:Midazolam / Q000494:pharmacology; D009200:Myocardial Contraction / Q000187:drug effects; D000077149:Sevoflurane; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D008874:Midazolam; D005283:Fentanyl; D006221:Halothane