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Comparison of the effect of inhaled anaesthetic with intravenous anaesthetic on pulmonary vascular resistance measurement during cardiac catheterisation

Published online by Cambridge University Press:  19 February 2014

Leonie A. Giesen ,
Michelle White  and
Robert M.R. Tulloh
Leonie A. Giesen
Affiliation:
Department of Congenital Heart Disease and Department of Anaesthesia, Bristol Heart Institute and Bristol Royal Hospital for Children, Bristol, United Kingdom
Michelle White
Affiliation:
Department of Congenital Heart Disease and Department of Anaesthesia, Bristol Heart Institute and Bristol Royal Hospital for Children, Bristol, United Kingdom
Robert M.R. Tulloh*
Affiliation:
Department of Congenital Heart Disease and Department of Anaesthesia, Bristol Heart Institute and Bristol Royal Hospital for Children, Bristol, United Kingdom
*
Correspondence to: Professor R. Tulloh, Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom. Tel: +44 117 342 8856; Fax: +44 117 342 8857; E-mail [email protected]
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Abstract

Background: Children with pulmonary hypertension routinely undergo pulmonary vascular resistance studies to assess the disease severity and vasodilator responsiveness. It is vital that results are accurate and reliable and are not influenced by the choice of anaesthetic agent. However, there are anecdotal data to suggest that propofol and inhalational agents have different effects on pulmonary vascular resistance. Methods: A total of 10 children with pulmonary hypertension were selected sequentially to be included in the study. To avoid confounding because of baseline anatomic or demographic details, a crossover protocol was implemented, using propofol or isoflurane, with time for washout in between each agent and blinding of the interventionalist. Results: Pulmonary and systemic vascular resistance were not significantly different when using propofol or isoflurane. However, the calculated resistance fraction – ratio of pulmonary resistance to systemic resistance – was significantly lower when using propofol than when using isoflurane. Conclusions: Although no difference in pulmonary vascular resistance was demonstrated, this pilot study suggests that the choice of anaesthetic agent may affect the calculation of relative pulmonary and systemic vascular resistance, and provides some preliminary evidence to favour propofol over isoflurane. These findings require replication in a larger study, and thus they should be considered in future calculations to make informed decisions about the management of children with pulmonary hypertension.

Keywords

Propofolisofluranepulmonary hypertensionpulmonary vascular resistancepaediatrics
Type
Brief Reports
Information
Cardiology in the Young , Volume 25 , Issue 2 , February 2015 , pp. 368 - 372
Copyright
© Cambridge University Press 2014 

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