Atrial Septal Defect, Dexmedetomidine, General Anesthesia, Ketamine, Local Infiltration
Conditions
Brief summary
The aim of the present study is to compare between general anesthesia versus sedation with dexmedetomidine and ketamine with local infilteration at the catheter insertion site in pediatric patients undergoing transcutaneous closure of atrial septal defect on hemodynamic changes.
Detailed description
Atrial septal defect (ASD) is one of the most common types of congenital heart defects, occurring in about 25% of children General anaesthesia is usually obtained with tracheal intubation and mechanical ventilation or spontaneous breathing, the depth of anesthesia required to tolerate the presence of a tracheal tube will invariably lead to some reduction in myocardial contractility and alteration of respiratory mechanics. The goal of anesthetic technique is to provide sedation and analgesia during cardiac catheterization to ensure immobility and hemodynamic stability. Ketamine is an N-methyl-D-aspartate receptor (NMDA) antagonist with sedative, analgesic, and sympathomimetic effects. Among its benefits ,it has the ability to protect airway reflexes with minimal effect on ventilatory drive. Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist with sedative, anxiolytic, and analgesic effect, it also blunts the sympathetic nervous system response to surgical stimulation.
Interventions
OTHERGeneral Anesthesia
General anesthesia will be induced by 6% sevoflurane with a face mask. An intravenous line(22-g cannula )will be inserted then fentanyl 1mcg-kg will be given . Endotracheal tube will be used to intubate the patient .Anesthesia will be maintained by 2%sevoflurane inhalation in an oxygen air compination 1:1 throught the operation . Crystalloid solution was used to replenish fluid according "4/2/1-rule". Monitoring during the procedure include , ejection fraction (EF),blood pressure, heart rate, respiratory rate, and O2 saturation are measured at baseline, after induction, 10 min after catheter insertion,30 min during procedure and post emergence.
OTHERLocal anesthesia
A nasal cannula was placed and oxygen delivered at 2 to 3 L/minute. An intravenous line will be inserted (22-g cannula). The sedation regimen will include loading dose of dexmedetomidine (1 mcg/kg) and ketamine (1mg/kg) over 10 minutes . The patient will receive an infusion of dexmedetomidine at 0.7 mcg/kg per hour and ketamine 0.5 mg/kg/hr as maintenance sedation .Local infilteration of xylocaine 2% at dose 2mg/kg will be given for vascular access in cardiac catheterization . After completion of the procedure the infusion pump will be stopped to ensure that the patient is fully awake and vitally stable
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to 8 Years
Healthy volunteers
No
Inclusion criteria
* Aged 3-8 years old. * Both genders. * American Society of Anesthesiologists (ASA) physical status II-III * Pediatric patients scheduled for elective transcatheter atrial septal defect closure.
Exclusion criteria
* Patients with multiple congenital anomalies. * Patients with congestive heart failure * Patients with Organ dysfunction liver or renal disease or pulmonary disease. * Recent chest infection. * Airway abnormalities.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate | Immediately after the intervention | Heart rate will be measured at baseline, after induction ,10 min after catheter insertion site,30 min during procedure and post emergence in both groups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial blood pressure | Immediately after the intervention | Mean arterial blood pressure will be measured at baseline, after induction ,10 min after catheter insertion site,30 min during procedure and post emergence in both groups. |
| O2 saturation | Immediately after the intervention | O2 saturation will be measured at baseline, after induction ,10 min after catheter insertion site,30 min during procedure and post emergence in both groups. |
| Respiratory rate | Immediately after the intervention | Respiratory rate will be measured at baseline, after induction ,10 min after catheter insertion site,30 min during procedure and post emergence in both groups. |
| Lengh of hospital stay | 28 days postoperative | Length of hospital stay will be measured from admission till discharge from hospital |
| Recovery time | Immediately after discharge from post-anesthesia care unit | Recovery time will be measured from the end of surgery till discharge from post-anesthesia care unit (PACU). |
| Complications | 24 hours postoperative | Postoperative complications such as arrythmia, hypotension, bradycardia, nausea and vomiting will be measured. |
Countries
Egypt
Outcome results
None listed