Isoflurane provides better myocardial protection than midazolam in pediatric patients during open heart surgeries
Egyptian Journal of Cardiothoracic Anesthesia. 2007; 1 (2): 97-106
in En
| IMEMR
| ID: emr-181529
Responsible library:
EMRO
Objectives: This study was designed to evaluate the applicability of anesthetic myocardial protection [pre-conditioning and minimization of reperfusion injury] using two anesthetic regimens on plasma levels of cardiac troponin T [cTnT], as a marker of myocardial ischemia, in pediatric patients assigned for surgical correction of congenital heart diseases using cardiopulmonary bypass [CPB]
Patients and Methods: The study included 60 patients [36 males and 24 females]. Patients were randomly allocated in 2 equal groups: Midazolam group received a continuous infusion of midazolam [0.2 mg/kg/hour] and Isoflurane group maintained by an end-tidal concentration of isoflurane of 1-1.5% throughout the operation. Six blood samples were taken for estimation of plasma cTnT levels immediately after induction of anesthesia [S1], 8- hours [S2], 16-hours [S3], 24-hours [S4], 36-hours [S5] and 48-hours [S6] after aortic cross-clamping
Results: Plasma cTnT levels estimated after aortic cross-clamping [S2-S6] showed a significant [P1<0.001] elevation in both groups compared to levels estimated in S1 sample. Moreover, plasma cTnT levels showed a progressive increase in all patients irrespective of anesthetic regimen used reaching a peak levels in S4 sample and started to decline thereafter but still significantly higher compared to levels estimated in S1 sample. Plasma cTnT levels estimated in S2 sample showed a non-significant increase in midazolam group compared to levels estimated in isoflurane group. On contrary, plasma cTnT levels estimated in midazolam group at 16, 24, 36 and 48 hours after aortic cross-clamping were significantly higher [P[6]=0.034, 0.01, <0.001 and =0.031, respectively] compared to levels estimated in isoflurane group. In midazolam group, there was a positive significant correlation between mechanical ventilation time and plasma cTnT levels estimated at 24-hours [r=0.413, p=0.023], respectively. However, such correlations were non-significant despite being positive in isoflurane group, [r=0.265, p>0.05]
Conclusion: It could be concluded that the hypothesis of anesthetic myocardial protection [preconditioning and minimization of reperfusion injury] is applicable for pediatric patients with congenital heart disease who are assigned for cardiac surgery. Isoflurane-based anesthesia minimized myocardial ischemic and reperfusion injury and provided efficient cardioprotection irrespective of the type of cardiac lesion
Patients and Methods: The study included 60 patients [36 males and 24 females]. Patients were randomly allocated in 2 equal groups: Midazolam group received a continuous infusion of midazolam [0.2 mg/kg/hour] and Isoflurane group maintained by an end-tidal concentration of isoflurane of 1-1.5% throughout the operation. Six blood samples were taken for estimation of plasma cTnT levels immediately after induction of anesthesia [S1], 8- hours [S2], 16-hours [S3], 24-hours [S4], 36-hours [S5] and 48-hours [S6] after aortic cross-clamping
Results: Plasma cTnT levels estimated after aortic cross-clamping [S2-S6] showed a significant [P1<0.001] elevation in both groups compared to levels estimated in S1 sample. Moreover, plasma cTnT levels showed a progressive increase in all patients irrespective of anesthetic regimen used reaching a peak levels in S4 sample and started to decline thereafter but still significantly higher compared to levels estimated in S1 sample. Plasma cTnT levels estimated in S2 sample showed a non-significant increase in midazolam group compared to levels estimated in isoflurane group. On contrary, plasma cTnT levels estimated in midazolam group at 16, 24, 36 and 48 hours after aortic cross-clamping were significantly higher [P[6]=0.034, 0.01, <0.001 and =0.031, respectively] compared to levels estimated in isoflurane group. In midazolam group, there was a positive significant correlation between mechanical ventilation time and plasma cTnT levels estimated at 24-hours [r=0.413, p=0.023], respectively. However, such correlations were non-significant despite being positive in isoflurane group, [r=0.265, p>0.05]
Conclusion: It could be concluded that the hypothesis of anesthetic myocardial protection [preconditioning and minimization of reperfusion injury] is applicable for pediatric patients with congenital heart disease who are assigned for cardiac surgery. Isoflurane-based anesthesia minimized myocardial ischemic and reperfusion injury and provided efficient cardioprotection irrespective of the type of cardiac lesion
Search on Google
Index:
IMEMR
Language:
En
Journal:
Egypt. J. Cardiothorac. Anesth.
Year:
2007