The hemodynamic effects of propofol in children with congenital heart disease

We studied the hemodynamic effects of propofol during elective cardiac cath eterization in 30 children with congenital heart disease. Sixteen patients were without cardiac shunt (Group I), six had left-to-right cardiac shunt ( Group II), and eight had right-to-left cardiac shunt (Group III). The mean (+/- SD) ages were 3.8 +/- 3.1 yr (Group I), 3.2 +/- 3.7 yr (Group II), and 1.0 +/- 0.6 yr (Group III). After sedation and cardiac catheter insertion, hemodynamic data and oxygen consumption were measured before and after the administration of propofol (2-mg/kg bolus, 50- to 200-mu g.kg(-1).min(-1) infusion), and values were compared by using a paired t-test (significance: P < 0.05). After the propofol administration, systemic mean arterial press ure and systemic vascular resistance decreased significantly and systemic b lood flow increased significantly in all patient groups; heart rate, pulmon ary mean arterial pressure, and pulmonary vascular resistance were unchange d. Pulmonary to systemic resistance ratio increased (Group I, P = 0.005; Gr oup II, P = 0.03; Group III, P = 0.10). In patients with cardiac shunt, pro pofol resulted in decreased left-to-right flow and increased right-to-left flow; the pulmonary to systemic flow ratio decreased significantly (Group I I, P = 0.005; Group III, P = 0.01). Clinically relevant decreases in Pao, ( P = 0.008) and SaO(2), (P = 0.01) occurred in Group III patients. We conclu de that propofol can result in clinically important changes in cardiac shun t direction and flow. Implications: The principal hemodynamic effect of pro pofol in children with congenital heart defects is a decrease in systemic v ascular resistance. In children with cardiac shunt, this results in a decre ase in the ratio of pulmonary to systemic blood flow, and it can lead to ar terial desaturation in patients with cyanotic heart disease.