Abstract
To evaluate the metabolic and oxidative effects of sevoflurane and propofol in children undergoing surgery for correction of congenital heart disease. Twenty children with acyanotic congenital heart disease, scheduled for elective cardiac surgery with cardiopulmonary bypass, age range 1 day to 14 years were randomly assigned to 2 groups: Group GP, programmed to receive total intravenous anesthesia with propofol and group GS scheduled to use balanced anesthesia with sevoflurane. Exclusion criteria were cyanotic heart disease or complex, association with other malformations, severe systemic diseases, infection or children undergoing treatment and palliative or emergency surgery. Blood samples were collected at three different time-points: T0, after radial artery cannulation, T1, 30 minutes after cardiopulmonary bypass (CPB) launch and T2, at the end of procedure. Parameters analyzed included thiobarbituric acid-reactive substance (TBARS), glutathione (GLN), lactate and pyruvate plasmatic concentrations. TBARS, GSH, lactate and pyruvate concentrations did not change significantly by Friedman´s test. Lactate/pyruvate ratio (L/P) was >10 in both groups. There was a moderate Pearson correlation for TBARS, in T1 (r=0.50; p=0.13) e T2 (r=0.51;p=0.12). Pearson correlation was high between groups during CPB (T1) for lactate (r=0.68; p=0.02), pyruvate (r=0.75; p=0.01) and L/P ratio (r=0.83; p=0.003). Anesthetic techniques investigated in this study showed a similar pattern, with no increase in metabolic substrates and oxidative stress during surgical correction of congenital heart defects in non-cyanotic children.
Highlights
Greater knowledge of congenital diseases linked to the development of new surgical techniques for correction of congenital defects has been responsible for the significant reduction of morbidity and mortality in pediatric patients[1]
Whereas the information available in the literature suggest that both the sevoflurane and propofol seem to have cardioprotective effect in children undergoing cardiac surgery, this study aimed to evaluate the influence of anesthetic technique on the occurrence of metabolic effects of surgical stress and inflammatory response associated with cardiopulmonary bypass (CPB), and on ischemia-reperfusion injuries in pediatric cardiac surgery
Anesthesia maintenance was performed in group GP with a continuous infusion of propofol 250 μg / kg / min until the onset of cardiopulmonary bypass followed by 200 μg propofol / kg / min during the course of CPB and propofol 150 μg / kg / min after the return of cardiocirculatory function
Summary
Greater knowledge of congenital diseases linked to the development of new surgical techniques for correction of congenital defects has been responsible for the significant reduction of morbidity and mortality in pediatric patients[1]. Despite all its achievements, the morbidity and mortality found in some centers, in relation to surgery performed during the neonatal period, are not negligible. Many of congenital heart disease considered inoperable in the past, are currently treated surgically[2]. The goal of anesthetic management of children with congenital heart disease is to ensure an ongoing intra-and postoperative cardiovascular stability with attenuation of the stress response and nociceptive stimulation. Congenital heart surgery (CHS) in children can be challenging as these procedures generate a systemic inflammatory reaction and endocrine-metabolic stress responses. Hyperglycemia is common during and after CHS3,4, and is associated with increased morbidity and mortality[5,6]
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