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Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease

Pediatric Cardiology volume 36, pages 543–549 (2015)Cite this article

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.

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Fig. 1

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

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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

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
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  2. Stephan Schubert
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  3. Peter Ewert
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  4. Brigitte Stiller
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  5. Nicole Nagdyman
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  6. Felix Berger
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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.

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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

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

Keywords

  • Cardiac output
  • Cerebral oxygenation
  • Near-infrared spectroscopy
  • Children
  • Propofol
  • Cerebral pressure auto-regulation