Common Inflammatory Markers and Outcome After Pediatric Cardiac Surgery With High Thoracic Epidural Anesthesia: A...

Area of Science:

• Pediatric Cardiac Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• High thoracic epidural analgesia (HTEA) is recognized for mitigating stress and neuroendocrine responses during cardiac surgeries.
• Its specific impact on inflammatory markers and organ system outcomes in pediatric patients undergoing cardiac surgery requires further elucidation.

Purpose of the Study:

• To evaluate the effect of HTEA on inflammatory markers (IL-6, IL-8, TNF-α) in pediatric cardiac surgery.
• To assess the impact of HTEA on pulmonary, renal, and cardiac function, mechanical ventilation duration, and hospital length of stay.

Main Methods:

• A randomized controlled trial involving 188 pediatric patients undergoing on-pump cardiac surgery.
• Patients were assigned to either the Epidural Group (HTEA with Bupivacaine infusion) or the Non-Epidural Group (fentanyl infusion).
• Data on inflammatory markers and organ system variables were collected at four time points: preoperatively and on postoperative days 1 and 2.

Main Results:

• The Epidural Group demonstrated significantly reduced inflammatory markers and shorter mechanical ventilation duration (19.5h vs 47.3h).
• Hospital length of stay was shorter in the Epidural Group (10.1 days vs 13.3 days).
• Improved pulmonary (PaO2, P/F ratio) and renal (NIRS) function were observed in the Epidural Group, with fewer complications like acute kidney injury requiring renal replacement therapy.

Conclusions:

• HTEA in pediatric on-pump cardiac surgery is associated with a reduction in inflammatory markers.
• HTEA positively influences organ system function, decreases mechanical ventilation duration, and shortens hospital length of stay.
• HTEA presents a favorable option for managing pediatric patients undergoing cardiac surgery.