CARDIOPROTECTION IN ANESTHESIOLOGICAL SUPPORT FOR PEDIATRIC OPEN HEART SURGERY: CLINICAL CAPABILITIES OF SEVOFLURANE

Abstract

Experimental studies have shown that volatile anesthetics can induce pharmacological preconditioning and reduce the degree of myocardial damage, however, clinical data in pediatric practice remain limited and contradictory. Objective. Compare the cardioprotective effects of sevofluron and total intravenous propofol anesthesia in children who underwent open-heart surgery using artificial blood circulation. Methods. A prospective one-centered study included 106 children aged 6 months to 5 years with congenital heart defects who underwent open-heart surgery with cardioplegic cardiac arrest. Patients were divided into two groups: sevofluran (n=53) and propofol (n=53). The primary endpoint was the maximum level of cardiospecific troponin T in the postoperative period. Secondary endpoints included the frequency of arrhythmias, indicators of hemodynamic stability, echocardiography data, the need for inotropic support, the duration of mechanical ventilation and stay in the intensive care unit. Results. In all observations, an increase in the level of cardiospecific troponin T after surgery was noted, however, its values were significantly lower in the sevofluran group at all stages of observation. After 3 hours, the level of cTnT was 1.2±0.3 ng/ml in the sevoflurane group and 1.9±0.4 ng/ml in the propofol group (p<0.05), after 8 hours-1.7±0.4 and 2.6±0.5 ng/ml respectively (p<0.01), after 12 hours-1.5±0.3 and 2.3±0.5 ng/ml (p<0.05), after 24 hours-1.1±0.2 and 1.8±0.3 ng/ml (p<0.05). Arrhythmias were registered in 11.3% of patients in the sevoflurane group and in 26.4% of patients in the propofol group (p<0.05). The need for inotropic support was lower when using sevoflurane (15.1% versus 32.1%, p<0.05). The time of artificial lung ventilation (9.2±3.1 versus 13.6±4.4 hours, p<0.01) and the duration of stay in the ICU (36±10 versus 52±14 hours, p<0.05) were significantly shorter in the sevoflurane group. Echo-indicators indicated a faster restoration of myocardial systolic and diastolic function in patients receiving sevoflurane. Conclusion. The use of sevoflurane in open-heart surgeries in children is associated with more pronounced cardioprotection compared to propofol, which is manifested by a lower degree of myocardial damage, more stable hemodynamics, and faster functional recovery of the heart in the early postoperative period.