Hemodynamic Responses to Etomidate in Pediatric Patients with Congenital Cardiac Shunt Lesions

Objective: The authors investigated the effects of intravenous etomidate on hemodynamics in children with congenital cardiac shunts Design: Prospective observational study. Setting. Catheterization laboratory in tertiary referral cardiac center. Participants: Thirty children with congenital cardiac shunt lesions. Interventions: Fifteen children having congenital right to left shunts (group A) and 15 children with left to right shunts (group B) were studied. Systemic mean arterial pressure (SMAP), mean pulmonary artery pressures (MPAP), right atrial pressures (RAP), and pulmonary artery wedge pressure (PAWP) were recorded. Systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), and pulmonary-to-systemic blood flow ratio (Qp/Qs) were calculated on room air at baseline and following a single dose of 0 3 mg/kg of etomidate. Measurements and Main Results: Heart rate (HR), SMAP, RAP, systemic blood flow (Qs), Qp/Qs, and SVRI did not show any significant change, whereas systemic arterial saturation increased from 77.3% to 79.3%, which was statistically but not clinically significant in the authors' opinion following etomidate in group A No significant differences in HR, SMAP, MPAP, PAWP, PVRI, SVRI, Qs, pulmonary blood flow (Qp), and Qp/Qs ratio were seen; whereas RAP, systemic, and pulmonary artery saturation decreased in group B after etomidate. Although statistically significant, the decreases were not clinically significant Conclusion: Etomidate at 0.3 mg/kg produces very minimal changes in hemodynamic parameters and shunt fraction in children with congenital shunt lesions. Crown Copyright (C) 2010 Published by Elsevier Inc. All rights reserved.