Effect of propofol and sevoflurane on acid-base balance during pediatric heart catheterization

Background. Propofol is routinely used for anesthesia during pediatric heart catheterization. Propofol infusion syndrome (PRIS) is a rare, but often fatal complication mainly defined as bradycardia with progress to asystolia during propofol infusion. Metabolic acidosis is regarded as an early warning sign of PRIS. In this study the effect of propofol and sevoflurane on serum base excess, pH and lactate have been examined during pediatric heart catheterization. Methods. In this prospective randomised study 42 children have been anesthetised for pediatric heart catheterization with propofol (N.=22) or sevoflurane (N.=20) with ethic committee approval. Base excess, pH and lactate were measured by blood gas analysis at the beginning, during and at the end of the procedure. Changes relative to baseline were analysed by paired t-Test with correction for multiple testing. The study was powered to detect a difference of 1.5 mmol.L-1 for base excess and lactate. Results: Base excess (-2.59 [2.33] vs. -4.48 [2.88]; P=0.0004, mean [standard deviation]) and pH (7.39 [0.05] vs. 7.36 [0.06], P=0.0008,) changed significantly in in the propofol group but not in the sevoflurane group. The number of patients with base excess < 5.0 increased in the propofol group only from 2 to 10 (P=0.016). Lactate decreased in both groups (1.1 [0.3] vs. 0.9 [0.2], P=0.003 for sevoflurane and 1.0 [0.3] vs. 0.8 [0.3], P=0.0004 for propofol). Conclusion. Propofol but not sevoflurane had an effect on base excess and pH during pediatric heart catheterization.