title: Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolam with 100% oxygen in children with congenital heart disease.
abstract: The cardiovascular effects of volatile anesthetics in children with congenital heart disease have been studied, but there are limited data on the effects of anesthetics on pulmonary-to-systemic blood flow ratio (Qp:Qs) in patients with intracardiac shunting. In this study, we compared the effects of halothane, isoflurane, sevoflurane, and fentanyl/midazolam on Qp:Qs and myocardial contractility in patients with atrial (ASD) or ventricular (VSD) septal defects. Forty patients younger than 14 yr old scheduled to undergo repair of ASD or VSD were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl/midazolam. Cardiovascular and echocardiographic data were recorded at baseline, randomly ordered 1 and 1.5 mean alveolar anesthetic concentration (MAC) levels, or predicted equivalent fentanyl/midazolam plasma levels. Ejection fraction (using the modified Simpson's rule) was calculated. Systemic (Qs) and pulmonary (Qp) blood flow was echocardiographically assessed by the velocity-time integral method. Qp:Qs was not significantly affected by any of the four regimens at either anesthetic level. Left ventricular systolic function was mildly depressed by isoflurane and sevoflurane at 1.5 MAC and depressed by halothane at 1 and 1.5 MAC. Sevoflurane, halothane, isoflurane, or fentanyl/midazolam in 1 or 1.5 MAC concentrations or their equivalent do not change Qp:Qs in patients with isolated ASD or VSD.
  
  
  CONCLUSIONS
  Sevoflurane, halothane, isoflurane, and fentanyl/midazolam do not change pulmonary-to-systemic blood flow ratio in children with atrial and ventricular septal defects when administered at standard anesthetic doses with 100% oxygen.
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin, Houston, TX 77030-2399, USA.
authors.forename: Tracy H
authors.initials: TH
authors.lastname: Laird
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Stayer
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rivenes
authors.forename: Mark B
authors.initials: MB
authors.lastname: Lewin
authors.forename: E Dean
authors.initials: ED
authors.lastname: McKenzie
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
authors.forename: Dean B
authors.initials: DB
authors.lastname: Andropoulos
mesh_terms: D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006221:Halothane / Q000008:administration & dosage / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D010100:Oxygen / Q000008:administration & dosage / Q000494:pharmacology*; D011652:Pulmonary Circulation / Q000187:drug effects*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl; D006221:Halothane