Ketamine infusion versus isoflurane for the maintenance of anesthesia in the prebypass period in children with tetralogy of Fallot.

OBJECTIVE

To evaluate the use of ketamine in comparison with isoflurane in the maintenance of anesthesia in children with tetralogy of Fallot.

DESIGN

Prospective, randomized study.

SETTING

University hospital.

PARTICIPANTS

Fifty children scheduled for correction of tetralogy of Fallot.

INTERVENTIONS: After intubation, patients were assigned randomly to receive 2 different anesthesia maintenance regimens: group I, isoflurane, 0 to 1% plus fentanyl, 0.1 microg/kg/min; group II, ketamine, 0 to 5 mg/kg/h, plus fentanyl, 0.1 microg/kg/min. Isoflurane concentration and ketamine infusion rate were adjusted to maintain arterial pressure within 25% of baseline. Hemodynamic and respiratory parameters were recorded at the end of 4 intervals: T0, before induction of anesthesia; T1, induction to 10 minutes postintubation; T2, 10 minutes postintubation to poststernotomy; and T3, poststernotomy to completion of catheterizations.

MEASUREMENTS AND MAIN

RESULTS

In comparing group I with group II, significant differences were observed in mean arterial pressure (p < 0.0001), heart rate (p < 0.01), arterial oxygen saturation (p < 0.0001), arterial oxygen tension (p < 0.001), arterial carbon dioxide tension (p < 0.001), arterial pH (p < 0.0001), base excess (p < 0.05), and arterial to end-tidal carbon dioxide tension difference (p < 0.01) at T3.

CONCLUSION

The use of ketamine anesthesia is recommended as an alternative maintenance regimen in children undergoing definitive correction of tetralogy of Fallot.