Myocardial performance index with sevoflurane-pancuronium versus fentanyl-midazolam-pancuronium in infants with a functional single ventricle.
BACKGROUND
Patients with congenital heart disease characterized by a functional single ventricle make up an increasing number of patients presenting for cardiac or noncardiac surgery. Conventional echocardiographic methods to measure left ventricular function, i.e., ejection fraction, are invalid in these patients because of altered ventricular geometry. Two recently described Doppler echocardiographic modalities, the myocardial performance index and Doppler tissue imaging, can be applied to single-ventricle patients because they are independent of ventricular geometry. This study assessed the changes in myocardial performance index and Doppler tissue imaging in response to two anesthetic regimens, fentanyl-midazolam-pancuronium and sevoflurane-pancuronium.


METHODS
Thirty patients aged 4-12 months with a functional single ventricle were randomized to receive fentanyl-midazolam or sevoflurane. Myocardial performance index and Doppler tissue imaging were measured by transthoracic echocardiography at baseline and two clinically relevant dose levels.


RESULTS
Sixteen patients receiving sevoflurane and 14 receiving fentanyl-midazolam were studied. Myocardial performance index was unchanged from baseline with either agent (fentanyl-midazolam: 0.50 +/- 15 baseline vs. 0.51 +/- 0.15 at dose 2; sevoflurane: 0.42 +/- 0.14 baseline vs. 0.46 +/- 0.09 at dose 2). Doppler tissue imaging S (systolic)- and E (early diastolic)-wave velocities in the lateral ventricular walls at the level of the atrioventricular valve annulus were unchanged in the sevoflurane group; however, both Doppler tissue imaging S- and E-wave velocities were decreased significantly from baseline at dose 1 and dose 2 with fentanyl-midazolam, consistent with decreased longitudinal systolic and diastolic ventricular function.


CONCLUSIONS
Myocardial performance index, a global measurement of combined systolic and diastolic ventricular function, is not affected by commonly used doses of fentanyl-midazolam or sevoflurane in infants with a functional single ventricle.
Ikemba
Catherine M
CM
Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Dallas, Texas, USA.
Su
Jason T
JT
Stayer
Stephen A
SA
Miller-Hance
Wanda C
WC
Eidem
Benjamin W
BW
Bezold
Louis I
LI
Hall
Stuart R
SR
Havemann
Luke M
LM
Andropoulos
Dean B
DB
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D017023:Coronary Angiography; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005283:Fentanyl; D006321:Heart / Q000187:drug effects*; D018610:Heart Bypass, Right; D006334:Heart Function Tests; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers; D008874:Midazolam; D003473:Neuromuscular Nondepolarizing Agents; D010100:Oxygen / Q000097:blood; D010197:Pancuronium; D018401:Sample Size; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D010197:Pancuronium; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl