Key result
Sedation for infant cardiac catheterization linked to ~55% fewer high-severity adverse events versus general anesthesia.
Why the study?
Anesthetic management influences cardiac catheterization procedures and potentially outcomes in children with congenital heart disease, but data and recommendations were lacking for infants.
Does sedation reduce high-severity adverse events compared to general anesthesia in infants <2 years old undergoing cardiac catheterization?
Cohort (n=619)
No
Does sedation reduce high-severity adverse events compared to general anesthesia in infants <2 years old undergoing cardiac catheterization?
Absolute Event Rate: 9% vs 20%
p-value: p=<0.01
Sedation for cardiac catheterization in infants <2 years old is safe and associated with fewer high-severity adverse events and reduced need for hemodynamic support compared to general anesthesia.
Supports sedation to potentially lower adverse events in infant catheterization; leaves open need for randomized confirmation.
Background: Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old. Methods: We conducted a monocentric, retrospective study of all catheterization procedures (2008–2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables. Results: 803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 (p = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) (p < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients (p = 0.05), smaller weights (p < 0.01), palliated status (OR 3.2 [1.2–8.9], p = 0.02), two-ventricle physiology (OR 7.3 [2.7–20.2], p < 0.01), cyanosis (OR 4.6 [2.2–9.8], p < 0.01), pulmonary hypertension (OR 5.6 [2.0–15.5], p < 0.01), interventional catheterization (OR 1.8 [1.1–3.2], p = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8–455.1], p = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2–12.0], p < 0.01). Conclusion: Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.
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Mikus et al. (2021) conducted a cohort in Congenital heart disease requiring cardiac catheterization (n=619). Sedation vs. General anesthesia was evaluated on High-severity adverse events (HSAE) (p=<0.01). Sedation for cardiac catheterization in infants <2 years old was associated with fewer high-severity adverse events compared to general anesthesia (9% vs 20%; p<0.01).
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