Comparison of Cardioprotective Effects of Volatile Anesthetics in Children Undergoing Ventricular Septal Defect Closure

Abstract

Volatile anesthetic agents may precondition the myocardium and protect against ischemia and infarction. Preconditioning by volatile anesthetic agents is well documented in adults but is underinvestigated in children. The present study compares the effect of preconditioning in children by three volatile anesthetic agents along with several other variables associated with cardioprotection. Eighty children scheduled for ventricular septal defect closure under cardioplegic arrest were assigned to preconditioning for five minutes after commencement of cardiopulmonary bypass (CPB) with one minimum alveolar concentration (MAC) of one of the following agents: isoflurane, sevoflurane, desflurane, or placebo (oxygen-air mixture). The plasma concentration of creatine kinase MB (CK-MB) was determined after initiation of CPB, and again 6 and 24 hours after admission to the intensive care unit (ICU) after surgery. Duration of inotropic support, mechanical ventilation, and length of ICU stay in all the groups were also recorded. Preconditioning with isoflurane, sevoflurane, and desflurane was associated with significantly decreased postoperative release of CK-MB as compared to placebo group at 6 (group 1: 237.2 ± 189, group 2: 69.8 ± 15.8, group 3: 64.7 ± 37.8, and group 4: 70.4 ± 26.7) and 24 hours (group 1: 192.4 ± 158.2, group 2: 67.7 ± 25.0, group 3: 85.7 ± 66.8, and group 4: 50.4 ± 31.6) after admission to ICU. No significant differences were observed in the CK-MB levels among the three volatile anesthetic agents. Duration of inotropic support, mechanical ventilation, and length of ICU stay were greater in placebo group as compared to other groups without reaching statistical significance. Volatile anesthetic appear to provide definite cardioprotection to pediatric myocardium. No conclusion can be drawn regarding the best preconditioning agent among isoflurane, sevoflurane, and desflurane.