The safety and efficacy of sevoflurane anesthesia in infants and children with congenital heart disease

We tested the hypothesis that sevoflurane is a safer and more effective ane sthetic than halothane during the induction and maintenance of anesthesia f or infants and children with congenital heart disease undergoing cardiac su rgery. With a background of fentanyl (5 mug/kg bolus, then 5 mug kg-l h-l), the two inhaled anesthetics were directly compared in a randomized, double -blinded, open-label study involving 180 infants and children. Primary outc ome variables included severe hypotension, bradycardia, and oxygen desatura tion, defined as a 30% decrease in the resting mean arterial blood pressure or heart rate, or a 20% decrease in the resting arterial oxygen saturation , for at least30 s. There were no differences in the incidence of these var iables; however, patients receiving halothane experienced twice as many epi sodes of severe hypotension as those who received sevoflurane (P = 0.03). T hese recurrences of hypotension occurred despite an increased incidence of vasopressor use in the halothane-treated patients than in the sevoflurane-t reated patients. Multivariate stepwise logistic regression demonstrated tha t patients less than 1 yr old were at increased risk for hypotension compar ed with older children (P = 0.0004), and patients with preoperative cyanosi s were at increased risk for developing severe desaturation (P = 0.049). Se voflurane may have hemodynamic advantages over halothane in infants and chi ldren with congenital heart disease.