Individualized Premedication Strategy In Congenital Heart Disease Children

Part Ⅰ Clinical observation of oral midazolam,intranasaldexmedetomidine and intranasal ketamine for premedication in infants and toddlers with ventricular septal defects associated with pulmonary hypertensionObjective To compare the efficacy and safety of oral midazolam（MID）,intranasal dexmedetomidine（DEX）and intranasal ketamine（KET）for premedication in children with ventricular septal defects associated with pulmonary hypertension（VSD+PH）.Methods Ninety infants and toddlers with VSD associated with PH scheduled for surgical repair of VSD were randomly assigned to receiving oral MID(0.5mg/kg,Group M_VSD),intranasal DEX(2μg/kg,Group D_VSD),and intranasal KET(2mg/kg,Group K_VSD).The acceptance of administration,HR,SpO₂,RR,P_ETCO₂,and sedation score before administration and at different time points after administration,scores of separation and intravenous cannulation 30min after administration,as well as adverse effects were observed.Results All patients initially enrolled in the three groups except five finished the study.The satisfaction rates of acceptance of administration and separation of Group M_VSD were significantly higher than those of other two groups（P<0.05）.Group K_VSD had the least onset time of sedation and the highest satisfaction rate of intravenous cannulation among three groups（P<0.05）.The HR at 20min,25min and 30min,SpO₂ 25min and 30min after administration in Group D_VSD were significantly lower than baseline values（P<0.05）.Both RR and P_ETCO₂ increased significantly in Group D_VSD at 25min and 30min after administration compared with before administration（P<0.05）.Conclusion Oral MID,intranasal DEX and intranasal KET premedication can provide good sedation for infants and toddlers with VSD associated with PH.Patients receiving oral MID have the best acceptance of administration and the highest satisfaction rate of separation.Satisfaction rate of intravenous cannulation score in Group K_VSD is significantly higher than in other two groups.Intranasal DEX for premedication in children with VSD associated with PH may result in increased P_ETCO₂ and decreased SpO₂.Part Ⅱ Clinical observation of oral premedication with midazolam,dexmedetomidine and ketamine in infants and toddlers with tetralogy of FallotObjective To compare the safety and efficacy of oral premedication with midazolam（MID）,dexmedetomidine（DEX）and ketamine（KET）in children with tetralogy of Fallot（TOF）.Methods Sixty infants and toddlers undergoing selective primary repair for TOF were randomly assigned to orally receiving MID（0.5mg/kg,Group MTOF）,DEX（5μg/kg,Group DTOF）,and KET（5mg/kg,Group KTOF）.The acceptance of administration,HR,Sp O2,and sedation score before administration and at different time points after administration,scores of separation and intravenous cannulation 30 min after administration,as well as adverse effects were observed.Results All patients initially enrolled finished the study,except that two of Group MTOF were excluded because of postponed surgery.Satisfaction rate of the acceptance of administration in Group DTOF was significantly higher than in other two groups（P<0.05）.There was no significant difference in onset time of satisfactory sedation among three groups（P>0.05）.The proportion of satisfactory separation score and satisfactory intravenous cannulation of Group KTOF was significantly higher than that of Group DTOF and Group MTOF（P<0.05）.There was no significant variation in HR or Sp O2 of three groups between the baseline and other time points（P>0.05）.Conclusion Oral premedication with MID,DEX and KET can provide safe and effective sedation for infants and toddlers with TOF.Patients receiving oral DEX have the best acceptance of administration.Scores of separation and intravenous cannulation in Group KTOF are higher than in Group DTOF and Group MTOF.