Propofol does not modify the hemodynamic status of children with intracardiac shunts undergoing cardiac catheterization

Immobility and cardiovascular stability are required for cardiac catheteriz ation. Pediatric patients need a type of sedation that also allows spontane ous ventilation without supplemental oxygen. Propofol has been adequate in hemodynamically stable patients with congenital heart disease undergoing ca rdiac catheterization. However, mild systemic hypotension caused by propofo l may increase a preexisting right-to-left shunt. The aim of this study is to evaluate. in pediatric patients scheduled for cardiac catheterization. t he effects of propofol on systemic and pulmonic circulations. Fifteen patie nts aged 18 months to 9 years were studied. After a fast of 4-6 hours for s olid food. the patient arrived at the cardiac catheterization suite. where an IV catheter was placed. Usual monitoring was used. For sedation. without supplemental oxygen. patients received 1 mug/kg of fentanyl followed by pr opofol (1-2 mg/kg) titrated to immobility during preparation of the groin. A continuous infusion of propofol (100 mug/kg/min) was also started to obta in immobility during the procedure. Hemodynamic data, including systemic ve nous, pulmonary artery and vein, aortic saturations, and pressures, were re corded; Q(p) and Q(s) were calculated. The same set of data was re-corded 4 minutes after discontinuation of propofol and when the patient was respond ing to tactile stimuli. Despite lower pressures during propofol infusion, a s compared with those pressures measured after discontinuation of propofol, the extent of the intracardiac shunt remained unchanged. Propofol seems to be an adequate sedative agent for pediatric patients undergoing cardiac ca theterization, including those with intracardiac shunts.