Skip to main content
SpringerLink
Log in

Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Propofol is a short-acting, intravenously administered hypnotic agent which is used in procedural sedation in children. Propofol is known to decrease systemic vascular resistance, arterial blood pressure and can lead to desaturations and decreased systemic perfusion in children with cardiac shunting. This may result in a reduction in cerebral blood flow and oxygenation. Near-infrared spectroscopy (NIRS) can monitor cerebral tissue oxygenation in the frontal neocortex. The objective of our study was to measure the changes in cerebral oxygen and blood supply after Propofol infusion in children with congenital heart disease. Propofol infusion may reduce cerebral oxygenation in children with congenital heart disease. The study group consisted of 32 children (f:m = 18:14), with median age of 49 (5–112) months and median weight of 15 (5–34) kg. We performed NIRS derived continuous measurement of cerebral oxygenation and cardiac output using Electrical velocimetry for 5 min before and after sedation with Propofol (1–2 mg/kg i.v.) for cardiac catheterization. Simultaneously, non-invasive arterial blood pressure and transcutaneous oxygen saturation were measured. Propofol sedation led to a significant decrease in mean arterial pressure (79 ± 16 vs. 67 ± 12 mmHg) (p = 0.01) and cardiac index (3.2 ± 0.8 vs. 2.9 ± 0.6 ml/min/m2) (p = 0.03). In contrast, cerebral tissue oxygenation index, increased significantly from 57 ± 11 to 59 ± 10 % (p < 0.05). Sedation with Propofol increased cerebral tissue oxygenation despite a decrease in cardiac index and arterial blood pressure. This may be caused by a decreased oxygen consumption of the sedated brain with intact cerebral auto-regulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

CHD:

Congenital heart defect

CO:

Cardiac output

CI:

Cardiac index

CPA:

Cerebral pressure autoregulation

deoxyHb:

Deoxygenated hemoglobin

HbD:

Hemoglobin difference

NIRS:

Near-infrared spectroscopy

O2Hb:

Oxygenated hemoglobin

cHb:

Total hemoglobin

THI:

Tissue hemoglobin index

TOI:

Tissue oxygenation index

SV:

Stroke volume

References

  1. Bartels SA, Bezemer R, de Vries FJ, Milstein DM, Lima A, Cherpanath TG, van den Meiracker AH, van Bommel J, Heger M, Karemaker JM, Ince C (2011) Multi-site and multi-depth near-infrared spectroscopy in a model of simulated (central) hypovolemia: lower body negative pressure. Intensive Care Med 37:671–677

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bilotta F, Fiorani L, La Rosa I, Spinelli F, Rosa G (2001) Cardiovascular effects of intravenous propofol administered at two infusion rates: a transthoracic echocardiographic study. Anaesthesia 56:266–271

    Article  CAS  PubMed  Google Scholar 

  3. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH (2009) The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 108:795–804

    Article  CAS  PubMed  Google Scholar 

  4. Ebert TJ (2005) Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans. Anesthesiology 103:20–24

    Article  CAS  PubMed  Google Scholar 

  5. Fleck T, Schubert S, Redlin M, Stiller B, Ewert P, Berger F, Nagdyman N (2010) Influence of external cardiac pacing on cerebral oxygenation measured by near-infrared spectroscopy in children after cardiac surgery. Paediatr Anaesth 20:553–558

    Article  PubMed  Google Scholar 

  6. Hershenson JA, Ro PS, Miao Y, Tobias JD, Olshove V, Naguib AN (2012) Changes in hemodynamic parameters and cerebral saturation during supraventricular tachycardia. Pediatr Cardiol 33:286–289

    Article  PubMed  Google Scholar 

  7. Ho CM, Tarng GW, Su CK (2007) Comparison of effects of propofol and midazolam at sedative concentrations on sympathetic tone generation in the isolated spinal cord of neonatal rats. Acta Anaesthesiol Scand 51:708–713

    Article  CAS  PubMed  Google Scholar 

  8. Laffey JG, Kavanagh BP (2002) Hypocapnia. N Engl J Med 347:43–53

    Article  CAS  PubMed  Google Scholar 

  9. Laycock GJ, Mitchell IM, Paton RD, Donaghey SF, Logan RW, Morton NS (1992) EEG burst suppression with propofol during cardiopulmonary bypass in children: a study of the haemodynamic, metabolic and endocrine effects. Br J Anaesth 69:356–362

    Article  CAS  PubMed  Google Scholar 

  10. Matcher SJ, Kirkpatrick P, Nahid K, Cope M, Delpy DT (1995) Absolute quantification methods in tissue near infrared spectroscopy. Proc SPIE 2389:486–495

  11. Menke J, Moller G (2014) Cerebral near-infrared spectroscopy correlates to vital parameters during cardiopulmonary bypass surgery in children. Pediatr Cardiol 35:155–163

    Article  PubMed  Google Scholar 

  12. Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H (2008) Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth 100:88–94

    Article  CAS  PubMed  Google Scholar 

  13. Ono M, Zheng Y, Joshi B, Sigl JC, Hogue CW (2013) Validation of a stand-alone near-infrared spectroscopy system for monitoring cerebral autoregulation during cardiac surgery. Anesth Analg 116:198–204

    Article  PubMed Central  PubMed  Google Scholar 

  14. Park HJ, Kim YL, Kim CS, Kim SD, Kim HS (2007) Changes of bispectral index during recovery from general anesthesia with 2 % propofol and remifentanil in children. Paediatr Anaesth 17:353–357

    Article  PubMed  Google Scholar 

  15. Petter H, Erik A, Bjorn E, Goran R (2011) Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution. Clin Physiol Funct Imaging 31:39–47

    Article  PubMed  Google Scholar 

  16. Ramaekers VT, Casaer P, Daniels H, Marchal G (1990) Upper limits of brain blood flow autoregulation in stable infants of various conceptional age. Early Hum Dev 24:249–258

    Article  CAS  PubMed  Google Scholar 

  17. Schubert S, Schmitz T, Weiss M, Nagdyman N, Huebler M, Alexi-Meskishvili V, Berger F, Stiller B (2008) Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 22:299–307

    Article  PubMed  Google Scholar 

  18. Sherry KM, Sartain J, Bell JH, Wilkinson GA (1995) Comparison of the use of a propofol infusion in cardiac surgical patients with normal and low cardiac output states. J Cardiothorac Vasc Anesth 9:368–372

    Article  CAS  PubMed  Google Scholar 

  19. Soul JS, Taylor GA, Wypij D, Duplessis AJ, Volpe JJ (2000) Noninvasive detection of changes in cerebral blood flow by near-infrared spectroscopy in a piglet model of hydrocephalus. Pediatr Res 48:445–449

    Article  CAS  PubMed  Google Scholar 

  20. Srinivasan M, Turmelle M, Depalma LM, Mao J, Carlson DW (2012) Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr 160(5):801–806

    Article  PubMed  Google Scholar 

  21. Suzuki S, Takasaki S, Ozaki T, Kobayashi Y (1999) A tissue oxygenation monitor using NIR spatially resolved spectroscopy. Proc SPIE 3579:144–145

    Google Scholar 

  22. Tirel O, Wodey E, Harris R, Bansard JY, Ecoffey C, Senhadji L (2008) Variation of bispectral index under TIVA with propofol in a paediatric population. Br J Anaesth 100:82–87

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Tomaske M, Knirsch W, Kretschmar O, Woitzek K, Balmer C, Schmitz A, Bauersfeld U, Weiss M (2008) Cardiac output measurement in children: comparison of Aesculon cardiac output monitor and thermodilution. Br J Anaesth 100:517–520

    Article  CAS  PubMed  Google Scholar 

  24. Tsuji M, duPlessis A, Taylor G, Crocker R, Volpe JJ (1998) Near infrared spectroscopy detects cerebral ischemia during hypotension in piglets. Pediatr Res 44:591–595

    Article  CAS  PubMed  Google Scholar 

  25. Williams GD, Jones TK, Hanson KA, Morray JP (1999) The hemodynamic effects of propofol in children with congenital heart disease. Anesth Analg 89:1411–1416

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Anne Gale for editorial assistance and Roya Modabber-Sartipi for support as a study nurse.

Funding

We received no support from extramural sources for this study.

Conflict of interest

None

Ethical Standards

The study was approved by the local ethics committee and written informed consent was given by the children’s parents.

Author information

Authors and Affiliations

  1. Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Thilo Fleck, Stephan Schubert & Felix Berger

  2. Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Centre Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany

    Thilo Fleck & Brigitte Stiller

  3. Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich, Lazarettstr. 36, 80636, Munich, Germany

    Peter Ewert & Nicole Nagdyman

Authors
  1. Thilo Fleck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan Schubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Ewert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brigitte Stiller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicole Nagdyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Felix Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thilo Fleck.

Additional information

Nicole Nagdyman and Felix Berger are shared last authorship.

The work was performed at the Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fleck, T., Schubert, S., Ewert, P. et al. Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease. Pediatr Cardiol 36, 543–549 (2015). https://doi.org/10.1007/s00246-014-1047-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-014-1047-7

Keywords

Search

Navigation