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Published on: October 23, 2018

Comparison of cardioprotective effects of volatile anesthetics in children undergoing ventricular septal defect

Pooja Singh1, Sandeep Chauhan, Gaurav Jain

  • 1Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. docanesthesia@gmail.com

World Journal for Pediatric & Congenital Heart Surgery
|June 27, 2013
PubMed

Insights

Volatile anesthetics like isoflurane, sevoflurane, and desflurane protect children's hearts during surgery. These agents significantly reduced cardiac enzyme release compared to placebo, indicating effective cardioprotection.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pediatric Surgery

Background:

  • Volatile anesthetic agents are known to precondition the myocardium, offering protection against ischemia and infarction.
  • While cardioprotective effects of volatile anesthetics are established in adults, their use in pediatric populations remains under-investigated.
  • This study investigates the cardioprotective potential of three volatile anesthetic agents in children undergoing cardiac surgery.

Purpose of the Study:

  • To compare the cardioprotective effects of isoflurane, sevoflurane, and desflurane in pediatric patients undergoing ventricular septal defect closure.
  • To evaluate the impact of volatile anesthetic preconditioning on postoperative cardiac enzyme release (CK-MB) and clinical outcomes.
  • To assess other variables associated with cardioprotection, including duration of inotropic support, mechanical ventilation, and intensive care unit (ICU) stay.

Main Methods:

  • Eighty pediatric patients undergoing ventricular septal defect closure were randomized into four groups: isoflurane, sevoflurane, desflurane, or placebo (oxygen-air).
  • Preconditioning with one minimum alveolar concentration (MAC) of the assigned agent was administered for five minutes post-cardiopulmonary bypass (CPB) initiation.
  • Plasma creatine kinase MB (CK-MB) levels were measured at baseline, and 6 and 24 hours post-ICU admission. Clinical outcomes were also recorded.

Main Results:

  • Preconditioning with isoflurane, sevoflurane, and desflurane significantly reduced postoperative CK-MB release at 6 and 24 hours compared to the placebo group.
  • No significant differences in CK-MB levels were observed among the three volatile anesthetic agents.
  • The placebo group showed trends towards longer durations of inotropic support, mechanical ventilation, and ICU stay, though not statistically significant.

Conclusions:

  • Volatile anesthetics demonstrate significant cardioprotective effects in the pediatric myocardium during cardiac surgery.
  • Isoflurane, sevoflurane, and desflurane appear equally effective in providing this cardioprotection.
  • Further research is needed to determine the optimal preconditioning agent among these volatile anesthetics.
Abstract

Keywords:
cardioprotectionpediatricpreconditioningventricular septal defectvolatile anesthetic agents

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