General Anesthesia for Cardiac Catheterization in Children

Chung, Wha Sung; Oh, Hung Kun; Robb, Ian S

Abstract

Cardiac catheterization in man was first deseribed by Forasmann in 1929 and introduced as a diagnostic procedure by Caurnand in 1941. The purpose of the catheterization is to evaluate the nature of cardiac abnormalities. The information from the ivnestigation includes pressure and oxygen content of blood in the various chamhers of the heart and the presence of abnormal communications between them. Most of the blood samplings and recordings of pressure at the various sites are not carried out simultaneously but are collected continuously. Therefore, a steady cardiorespiratory state is essential during the procedure in order to allow comparison of pressure and oxygen saturation observed at all stages of the procedure. Inhalation anesthesia used to provide a steady state in children might alter the pressures or oxygen saturatian because of its higher inspired oxygen content. Therefore room air breathing is essential far this investigation. In Yonsei Medical Center, from September 1964 to December 1974 we used thiopental (1964~1970) and ketamine (1971 ~1974) with spontaneous respiration in 170 children with congenital .heart disease, ranging in age from 50 days to 13 years. Thiopental was administered rectally (38 cases) intravenously (10 cases) and both together (10 cases), Ketamine was administered intravenously (13 cases), intramuscularly (8 cases) and both together 119 cases). For premedication, secobarbital was given orally one and a half hours before. Atropine was omitted. The rate of administration, time of operation, anesthesia and. recovery, and alteration in body temperature, blood pressure, pulse rate and respiratory rate were observed statistically. It was concluded that: In the ketamine groups. 1) General anesthesia was obtained satisfactorily without frequent administration and supplementary administration of meperidine or diazepam. Furthermore the drug is stable and requires no prior mixing. 2) Sleep occurs quickly after both intravenous ar intramuscular injection and analgesia is profound. Therefore investigation was begun quickly after injection, and time of operation and anesthesia was shorter. 3) Postoperative increase in body temperature was observed but less than when thiopental was administered. 4) Blood pressure, pulse rate and respiratory rate were increased 5~18% after induction. but returned to previous state after about 15 minutes. 5) Cardiovascular complication was minimal. Profuse salivation was seen in 0.8% of patients, but there were preservation of jaw tone and laryngo-pharyngeal reflexes, so maintenance of the airway was excellent if suction was available. In conclusion, general anesthesia using ketamine was superior to thiopental for cardiac catheterization in children.

General Anesthesia for Cardiac Catheterization in Children

Abstract

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