Comparison of sevoflurane and ketamine for anesthetic induction in children with congenital heart disease.
BACKGROUND
Sevoflurane is widely used in pediatric anesthesia for induction. Ketamine has been preferred in pediatric cardiovascular anesthesia. Aim of this study was to compare the hemodynamic effects and the speed of ketamine and sevoflurane for anesthesia induction in children with congenital heart disease.


METHODS
Children with congenital heart disease undergoing corrective surgery were included in the study. After oral premedication with midazolam (0.5 mg.kg(-1)), anesthesia induction was started with 5 mg.kg(-1) intramuscular ketamine (group K). In the second group, induction was achieved with sevoflurane (group S); the first concentration was 3% and increased after every three breaths. Intravenous access time and intubation times were enrolled for each child. Hemodynamic data and oxygen saturation were recorded every 2 min and any event during induction period was also noted.


RESULTS
Forty-seven children were included in the study; 23 in group K and 24 in group S. Heart rates and oxygen saturation values were similar between groups during the study. No difference was found between intravenous access time and intubation times. However, blood pressure levels were significantly lower in group S after recording baseline values till the intubation time (at 4, 6, and 8 min). Respiratory complications observed during the study were mild and were less frequent in group K than in group S (4 vs 13).


CONCLUSIONS
Ketamine appears a good alternative for induction in patients with congenital heart disease. It permits preservation of hemodynamic stability with minimal side effects.
Department of Anesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. zerrin_sr@yahoo.com
Zerrin
Z
Sungur Ulke
Umut
U
Kartal
Mukadder
M
Orhan Sungur
Emre
E
Camci
Mehmet
M
Tugrul
D000778:Anesthetics, Dissociative / Q000494:pharmacology*; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000494:pharmacology*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D010100:Oxygen / Q000097:blood; D011229:Preanesthetic Medication; D011446:Prospective Studies; D000077149:Sevoflurane; D013997:Time Factors; D016896:Treatment Outcome
D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D007649:Ketamine; D010100:Oxygen