title: The safety and efficacy of sevoflurane anesthesia in infants and children with congenital heart disease.
abstract: We tested the hypothesis that sevoflurane is a safer and more effective anesthetic than halothane during the induction and maintenance of anesthesia for infants and children with congenital heart disease undergoing cardiac surgery. With a background of fentanyl (5 microg/kg bolus, then 5 microg. kg(-1). h(-1)), the two inhaled anesthetics were directly compared in a randomized, double-blinded, open-label study involving 180 infants and children. Primary outcome variables included severe hypotension, bradycardia, and oxygen desaturation, defined as a 30% decrease in the resting mean arterial blood pressure or heart rate, or a 20% decrease in the resting arterial oxygen saturation, for at least 30 s. There were no differences in the incidence of these variables; however, patients receiving halothane experienced twice as many episodes of severe hypotension as those who received sevoflurane (P = 0.03). These recurrences of hypotension occurred despite an increased incidence of vasopressor use in the halothane-treated patients than in the sevoflurane-treated patients. Multivariate stepwise logistic regression demonstrated that patients less than 1 yr old were at increased risk for hypotension compared with older children (P = 0.0004), and patients with preoperative cyanosis were at increased risk for developing severe desaturation (P = 0.049). Sevoflurane may have hemodynamic advantages over halothane in infants and children with congenital heart disease.
  
  
  CONCLUSIONS
  In infants and children with congenital heart disease, anesthesia with sevoflurane may result in fewer episodes of severe hypotension and less emergent drug use than anesthesia with halothane.
authors.affiliation: Department of Anesthesia and Perioperative Care, Division of Pediatric Cardiac Surgery, University of California-San Francisco, 521 Parnassus Ave., C450, San Francisco, CA 94143-0648, USA.
authors.forename: I A
authors.initials: IA
authors.lastname: Russell
authors.forename: W C
authors.initials: WC
authors.lastname: Miller Hance
authors.forename: G
authors.initials: G
authors.lastname: Gregory
authors.forename: M C
authors.initials: MC
authors.lastname: Balea
authors.forename: L
authors.initials: L
authors.lastname: Cassorla
authors.forename: A
authors.initials: A
authors.lastname: DeSilva
authors.forename: R F
authors.initials: RF
authors.lastname: Hickey
authors.forename: L M
authors.initials: LM
authors.lastname: Reynolds
authors.forename: K
authors.initials: K
authors.lastname: Rouine-Rapp
authors.forename: F L
authors.initials: FL
authors.lastname: Hanley
authors.forename: V M
authors.initials: VM
authors.lastname: Reddy
authors.forename: M K
authors.initials: MK
authors.lastname: Cahalan
mesh_terms: D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005283:Fentanyl; D006221:Halothane / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008738:Methyl Ethers / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D006221:Halothane