Singh Pooja, Chauhan Sandeep, Jain Gaurav, Talwar Sachin, Makhija Neeti, Kiran Usha
Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
World J Pediatr Congenit Heart Surg. 2013 Jan;4(1):24-9. doi: 10.1177/2150135112457580.
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.
挥发性麻醉剂可能对心肌产生预处理作用，从而预防缺血和梗死。挥发性麻醉剂的预处理作用在成人中已有充分记录，但在儿童中研究较少。本研究比较了三种挥发性麻醉剂对儿童的预处理效果以及其他一些与心脏保护相关的变量。
80名计划在心脏停搏下行室间隔缺损修补术的儿童，在体外循环（CPB）开始后，用以下一种药物的一个最低肺泡浓度（MAC）进行5分钟的预处理：异氟烷、七氟烷、地氟烷或安慰剂（氧气 - 空气混合物）。在CPB开始后以及术后入住重症监护病房（ICU）6小时和24小时后测定肌酸激酶MB（CK - MB）的血浆浓度。记录所有组的正性肌力支持时间、机械通气时间和ICU住院时间。
与安慰剂组相比，在入住ICU 6小时（第1组：237.2±189，第2组：69.8±15.8，第3组：64.7±37.8，第4组：70.4±26.7）和24小时（第1组：192.4±158.2，第2组：67.7±25.0，第3组：85.7±66.8，第4组：50.4±31.6）时，用异氟烷、七氟烷和地氟烷预处理可使术后CK - MB释放显著减少。三种挥发性麻醉剂之间的CK - MB水平无显著差异。与其他组相比，安慰剂组的正性肌力支持时间、机械通气时间和ICU住院时间更长，但未达到统计学意义。
挥发性麻醉剂似乎能为小儿心肌提供确切的心脏保护作用。关于异氟烷、七氟烷和地氟烷中哪种是最佳预处理药物尚无定论。
