Persistent cardiac arrhythmias in pediatric patients: effects of age, expired carbon dioxide values, depth of anesthesia, and airway management.

Abstract

The presence of persistent arrhythmias was correlated with hypercarbia (end-tidal CO2 greater than or equal to 55 mm Hg for greater than or equal to 60 s). A continuous strip chart recording of oxygen saturation, a capnogram, and an electrocardiogram were obtained from 402 children. No episodes of arrhythmia occurred in 153 patients younger than 2 yr compared with 24 patients 2 yr of age or older (P = 0.0001). Older patients whose airways were managed via a mask had a higher incidence (13.2% [21 of 159 patients]) than tracheally intubated patients (3.3% [3 of 90 patients]) (P = 0.01). In older patients whose tracheas were intubated, hypercarbia was associated with arrhythmia in 1 of 20 hypercarbia episodes. Seven of 16 patients with hypercarbia, whose airways were managed via a mask, had an arrhythmia (P = 0.0014); in eight, arrhythmias were associated with light anesthesia; in seven, arrhythmias were not associated with either hypercarbia or light anesthesia. Arrhythmias developed in 13 of 55 patients 2 yr old or older whose airways were managed via a mask and who were undergoing orchiopexy or herniorrhaphy as compared with 1 of 30 tracheally intubated patients (P = 0.016). There was a higher incidence of arrhythmias during halothane anesthesia compared with that during all other techniques (P = 0.035). The authors conclude that the incidence of arrhythmias is extremely low in infants younger than 2 yr. Hypercarbia is associated with arrhythmias in pediatric patients whose airways are managed via a mask but not in patients whose tracheas are intubated.(ABSTRACT TRUNCATED AT 250 WORDS)