Effect of different induction techniques on the inflammatory response in pediatric cardiac surgery

ABSTRACT

Many drugs administered for the purposes of anesthesia and sedation, possess potentially important immunomodulatory effects. Most data in this area is experimental. However, developments in this emerging field are worthy of consideration in the light of their future therapeutic potential. This study was designed to determine the effect of using different induction drugs on adhesive molecules plus the anti-inflammatory cytokine 5nterleukin-10 [IL-10] in pediatrics undergoing cardiac surgeries. 45 pediatric patients undergoing congenital cardiac surgeries correction [ASD, VSD, TOP] All children above one year were premedicated with 0.5 mg/Kg oral midazolam half an hour before coming to operating room. Patients were randomly assigned to one of three equal groups that differed only in the induction agent used; Group K Fentanyl 5 ng/Kg plus intravenous ketamine 2mg/Kg. Group S Fentanyl 5 microg/Kg plus gradual inhalatinal sevoflurane induction from 0% and up to 6%. Group E Fentanyl 5 microg/Kg plus Etomidate 0.3 mg/Kg. The effect of the three induction drugs, on adhesive molecules plus interleukin-10 [IL-10], was assessed before induction, intraoperative, and 4 hours post operative. The groups were similar with respect to heart rate, systolic blood pressure, and oxygen saturation SP02 [P > 0.1]. Starting after induction [T2] till 4 hours after operation [T6], Ketamine and sevoflurane groups showed significant lower serum soluble intercellular adhesion molecule-1 [sICAM] level compared with Etomidate groups [P <0.0001]. There were statistically increased IL-10 level in ketamine group at T4, T5, T6, compared to the other two groups. Conclusion: In contrast to etomidate anesthesia, ketamine and sevoflurane reduce the up-regulation of slCAM-1 level; therefore the inflammatory response can be attenuated. Only ketamine can potentiate the anti-inflammatory defense through increasing the IL-10 in pediatric patients undergoing cardiac surgeries