[Electrophysiological effects of sevoflurane in comparison with propofol in children with Wolff-Parkinson-White syndrome].
OBJECTIVE
To evaluate the electrophysiological effects of sevoflurane in children with Wolff-Parkinson-White (WPW) syndrome undergoing radiofrequency ablation.


METHODS
We performed a prospective study of 15 patients with WPW syndrome who were scheduled for an electrophysiological study (EPS) and radiofrequency ablation. Anesthesia was induced with fentanyl (2 microg/kg), propofol (3 mg/kg), and vecuronium (0.1 mg/kg), and initially maintained using propofol (100 microg/kg), with bolus administration of fentanyl and vecuronium as required. Four intracardiac catheters were introduced for the EPSpropofol, which included measurements of sinus-node function, sinoatrial-node conduction, refractory periods (atrial, AV-node, accessory pathway anterograde and retrograde, and ventricular), and the characteristics of induced orthodromic tachycardia. The propofol was then replaced with sevoflurane (1 MAC adjusted for age) and the measurements were repeated (EPSsevoflurane). The EPSpropofol and EPSsevoflurane data were compared using the Wilcoxon signed-rank test.


RESULTS
The mean (SD) age was 9.3 (6) years. After administration of sevoflurane, the duration of the antegrade effective refractory period of the accessory pathway increased (EPSpropofol, 283 (22) ms; EPSsevoflurane, 298 (25) ms; P = .004), as did the duration of the minimum pacing cycle with 1:1 atrioventricular conduction (EPSpropofol, 244 (41) ms; EPSsevoflurane, 273 (28) ms; P = .028). No significant changes were observed in the other parameters. Ablation of the accessory pathway was achieved in all patients.


CONCLUSIONS
Sevoflurane partially modified the properties of the accessory pathway but did not prevent ablation.
Pérez
E Rodríguez
ER
Servicio de Anestesia y Reanimación Infantil, Hospital Infantil La Paz, Madrid. erodriguezpemilio@gmail.com
Bartolomé
F Benito
FB
Carretero
P Sanabria
PS
Fernández
C Sánchez
CS
Mateos
E Jiménez
EJ
Tarlovsky
L Goldman
LG
D000293:Adolescent; D018681:Anesthetics, General / Q000494:pharmacology*; D006328:Cardiac Catheterization / Q000187:drug effects; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D005283:Fentanyl; D006329:Heart Conduction System / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008738:Methyl Ethers / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D014673:Vecuronium Bromide; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology* / Q000601:surgery
D018681:Anesthetics, General; D008738:Methyl Ethers; D000077149:Sevoflurane; D014673:Vecuronium Bromide; D005283:Fentanyl; D015742:Propofol