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Role of sevoflurane in organ protection during cardiac surgery in children: a randomized controlled trial

Dominique A Bettex1, Patrick M Wanner2, Marco Bosshart3

  • 1Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland dominique.bettex@usz.ch.

Interactive Cardiovascular and Thoracic Surgery
|November 19, 2014
PubMed

Insights

Sevoflurane did not offer superior heart protection in pediatric cardiac surgery. However, it may benefit infants under six months compared to midazolam, warranting further investigation in specific groups.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pediatric Surgery

Background:

  • Volatile anesthetics show in vitro protective effects against ischemia-reperfusion injury, but clinical results vary.
  • Clinical evidence on sevoflurane's cardioprotective benefits in pediatric cardiac surgery remains inconclusive.
  • This study investigates sevoflurane's efficacy compared to total intravenous anesthesia (TIVA) in children undergoing cardiopulmonary bypass (CPB).

Purpose of the Study:

  • To determine if sevoflurane provides superior cardioprotection compared to TIVA in pediatric cardiac surgery.
  • To evaluate perioperative cardiac function, clinical outcomes, and organ function as secondary endpoints.
  • To explore potential subgroup benefits of sevoflurane in pediatric patients.

Main Methods:

  • A randomized controlled trial involving 60 children with heart defects undergoing elective cardiac surgery on CPB.
  • Patients were randomized to receive either sevoflurane or TIVA (midazolam or propofol based on age).
  • Primary endpoint was postoperative peak cardiac troponin I/T; secondary endpoints included cardiac function, clinical outcomes, and organ function.

Main Results:

  • No significant difference in peak troponin levels or secondary outcomes between sevoflurane and TIVA groups overall.
  • A subgroup analysis revealed significantly lower postoperative troponin levels in acyanotic infants under 6 months who received sevoflurane compared to midazolam.
  • No differences in secondary outcomes were observed in this subgroup.

Conclusions:

  • Sevoflurane did not demonstrate superior myocardial protection in the general pediatric cardiac surgical population.
  • Sevoflurane may offer a cardioprotective benefit in acyanotic infants under six months compared to midazolam.
  • Further research is needed to explore the conditioning effects of sevoflurane in specific pediatric subgroups.
Abstract

Keywords:
Cardiac surgery in childrenOrgan protectionPreconditioningVolatile anaesthetics

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