Continuous oesophageal aortic blood flow echo-Doppler measurement during general anaesthesia in infants

Purpose: Invasive haemodynamic monitoring during general anaesthesia in infants is usually limited to very high risk operations, such as cardiac surgery. Nevertheless, different surgical procedures and/or anaesthetic techniques justify additional monitoring for children, as for adults. The aim of this preliminary study was to evaluate the feasibility of using a new echo-Doppler device (Dynemo 3000(R)) capable of measuring continuous aortic blood flow during general anaesthesia in infants. Methods: Aortic blood flow (ABF) was measured with a small oesophageal probe designed for newborns and infants. The aortic flowmeter was connected with satellite devices to visualise the haemodynamic profile which included ABF; pre-ejection period (PEPi), left ventricular ejection time (LVETi), mean arterial pressure, heart rate, stroke volume and systemic vascular resistance. Twelve infants, aged 8-26 mo, undergoing surgery under general anaesthesia were successively included in the evaluation of this device. Isoflurane (1% end-expired concentration) was introduced to maintain anaesthesia after induction with halothane, midazolam, fentanyl and atracurium. Results: Correct positioning of the probe was easily obtained in all cases and the recording quality was excellent, whatever the operative position. Recordings of haemodynamic data showed some myocardial depression from isoflurane: decreased ABF (indexed to body surface area) and lengthened PEP/LVET (2.24 +/- 0.53 L.min(-1).m(-2) and 0.32 +/- 0.05 respectively, before introduction of isoflurane and 1.71 +/- 0.53 L.min(-1).m(-2) (P = 0.027) and 0.39 +/- 0.06 (P = 0.007) with isoflurane). Conclusion: These preliminary results suggest that this continuous ABF echo-Doppler device may be valuable for peri anaesthetic monitoring in infants.