Age-specific hemodynamic profiles during pediatric anesthesia induction: a prospective study using carotid artery auto doppler flow technology

Perioperative hemodynamic monitoring is essential for maintaining cardiovascular stability, fluid optimization, and complication prevention. Children differ physiologically from adults, with smaller vascular calibers, immature autonomic regulation, and higher resting heart rates. Yet, age-specific descriptive hemodynamic data, especially during preoperative and peri-induction periods, remain lacking, hindering recognition of abnormal changes and tailored management. We prospectively enrolled 819 children aged 1–9 years undergoing elective non-cardiac surgery. Hemodynamic parameters were measured using the CADFlow® Doppler system at 3, 6, and 9 min post-induction. Key parameters included velocity time integral (VTI), cardiac output (CO), stroke volume (SV), pulsatility index (PI), and others. Patients were stratified into four age groups. Non-parametric tests (Friedman, Kruskal–Wallis) with FDR correction assessed temporal and inter-group differences. Inter-parameter correlations were assessed using Spearman’s rank correlation. HR declined with age and decreased slightly over time in older children. VTI increased with age and rose over time in the younger groups. CO increased with age and showed a small temporal rise only in the 1–2-year group, while PI remained age-dependent but temporally stable. Strong positive correlations were observed between CO, central venous pressure (CVP), and SV, while systemic vascular resistance (SVR) showed strong inverse correlations with these parameters. The 4–6 years group had the highest CO and VTI values, while the youngest group showed the lowest pulsatility indices. Age-specific trends were evident, and most parameters demonstrated significant variation either temporally or between age groups (p < 0.05). This study provides the first large-scale, age-stratified descriptive hemodynamic profiles of pediatric anesthesia induction using CADFlow®. These benchmarks enable more precise, age-adapted interpretation of cardiovascular dynamics in children, and offer a foundation for goal-directed fluid therapy and decision support in pediatric anesthetic care. Chinese Clinical Trial Registry (ChiCTR), Registration No. ChiCTR2300076813, https://www.chictr.org.cn/bin/project/edit?pid=210106; Date of Registration: 2023-10-19.