Comparison of Inhalational and Intravenous Anesthesia Induction on Electroencephalogram and Cerebral Perfusion in Children With Congenital Heart Disease: A Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVES

The effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction.

DESIGN

A randomized controlled trial.

SETTING

Operating room in 2 tertiary hospitals.

PARTICIPANTS

A cohort of 116 pediatrics patients undergoing cardiac surgery.

MEASUREMENTS AND MAIN

RESULTS

The patients were randomly assigned to either the intravenous group (n = 58) or the inhalational group (n = 58). The inhalational group received anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, whereas the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison with the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (p < 0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (p < 0.05 for all).

CONCLUSIONS

The administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared with the use of intravenous medications for anesthesia induction.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR1800015946).