Drug
Induction
Maintenance
Ketamine
0.5–2 mg/kg
0.01–0.05 mcg/kg/min
Midazolam
0.1–0.3 mg/kg
1–3 mcg/kg/min
Propofol
1–2 mg/kg
3–5 mg/kg/h
Sevoflurane
3–5 %
1–2 %
Fentanyl
3–5 mcg/kg
1–2 mcg/kg/min
Morphine
0.1 mg/kg
1–2 mcg/kg/min
Cisatracurium
0.1–0.2 mg/kg
1–2 mcg/kg/min
Dexmedetomidine
1 mcg/kg
0.2–1.4 mcg/kg/h
Midazolam is safely used to maintain sedation, usually in combination with fentanyl or morphine.
The use of muscle relaxants that permit to keep the patient ventilated under general anaesthesia is nowadays safe, because the introduction of many newer agent with low rate of adverse effects; the combination of modern volatile anaesthetics and modern muscle relaxants have reduced to very rare event the incidence of malignant hyperthermia.
Cisatracurium, a non-depolarising muscle relaxant, a cis-isomer of atracurium, is indicated in paediatric anaesthesia because of the absence of histamine release; its half-life is 22–29 min and it is eliminated through the Hoffman metabolism, so it can be used safely in patients with poor renal function.
2.3 Monitoring and Anaesthetic Equipment in the Cardiac Catheterisation Laboratory
2.3.1 Electrocardiogram
Electrocardiogram is used for continuous monitoring of heart rate, rhythm and ST changes throughout the pre-, intra- and post-procedural phases.
2.3.2 Blood Pressure
Systemic blood pressure may be monitored noninvasively during the most common procedures by an automated oscillometric technique.
During risky procedures or in very sick patients, it may be necessary to monitor invasive blood pressure, by cannulation of an artery. Thereby arterial cannulas, transducers, and flushing devices must be present in the laboratory.
2.3.3 Pulse Oximetry
It provides a continuous and noninvasive monitor of oxygen saturation, which is mandatory during both sedation and general anaesthesia in paediatric cardiac patients, who are at risk for the development of hypoxia.
2.3.4 Capnometry
Is a continuous and noninvasive method of measurement of expired carbon dioxide and is very useful to monitor the adequacy of ventilation during general anaesthesia or to detect malfunction or failure of the anaesthesia machine. Moreover, it provides a useful information related to the quality of pulmonary perfusion and can reflect haemodynamic changes.
2.3.5 Temperature Monitoring
Temperature monitoring is very important especially in the newborns, who are at risk for hypothermia because of their relatively large surface area and the inefficiency of their thermoregulatory mechanisms. Cutaneous temperature may be monitored by adequate probes. Central temperature, if required, can be measured using a nasogastric probe.
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