Anesthesiology: Feb 2001

Reviewer: Ann Bailey, MD

Summary: 54 kids having congenital heart surgery were randomized to one of the 4 anesthetics above. Echos were done intraop at 1 and 1.5 MAC (or MAC-equivalent in the fentanyl-versed group).

Results (2 table formats, same data):

	HR	MAP	LV Syst Fnc	CI
Halo	No change	Greatest dec	Dec	Dec at 1.5. SVRI also dec.
Sevo	No change	Dec	Dec EF at 1.5 MAC	No change
Iso	Inc at both MACs	Dec more than sevo	No change	No change
Fent/ Versed	Dec from 106 to 80’s	Dec same as sevo	No change	Dec at both levels

(Inc = increased, Dec = decreased)
 

	Halo	Sevo	Iso	Fent/ Versed
HR	No change	No change	Inc at both MACs	Dec from 106 to 80’s
MAP	Greatest dec	Dec	Dec more than sevo	Dec same as sevo
LV Syst Fnc	Dec	Dec EF at 1.5 MAC	No change	No change
CI	Dec at 1.5 MAC	No change	No change	Dec at both levels
SVRI	Dec

(Inc = increased, Dec = decreased)

Conclusions: Halothane is a cardiac depressant!!!  Forane may be slightly better than sevo at maintaining systemic CO esp at higher concentrations;  fentanyl-versed depressed CO because of decreased HR.

This study looked at kids with congenital lesions having repairs. The data are applicable to all the kids who come for noncardiac surgery and need anesthesia. It is reassuring that the old reliable Forane is seemingly as good as it gets for hemodynamic stability.