Objective
The authors aimed to compare the anti-inflammatory and antioxidant effects of propofol
and sevoflurane in children with cyanotic congenital heart disease (CCHD) undergoing
cardiac surgery with cardiopulmonary bypass.
Design
Prospective, randomized, double-blind study.
Setting
Single center, university hospital.
Participants
Children ages 1-10 years with CCHD undergoing elective cardiac surgery with cardiopulmonary
bypass.
Interventions
Children were randomized to receive general anesthesia with either sevoflurane (group
S) or propofol (group P). Systemic inflammatory response syndrome (SIRS) occurrence
was assessed at the end of the surgery and at the sixth, 12th, and 24th postoperative
hours. Blood samples were obtained at 4 times: after anesthesia induction (T0), after
release of the aortic cross-clamp (T1), at the end of the surgery (T2), and at the
postoperative 24th hour (T3). The serum levels of interleukin 6 and tumor necrosis
factor alpha, and the total antioxidant status (TAS) and total oxidant status, were
analyzed.
Results
SIRS was more common in group S than in group P at all times (p = 0.020, p = 0.036,
p = 0.004, p = 0.008). There were no significant differences between the groups in
the mean tumor necrosis factor alpha and interleukin 6 levels at any time. The TAS
level at T2 was higher in group P than group S (p = 0.036). The serum TAS level increased
at T2 compared with T0 in group P, but it decreased in group S (p = 0.041).
Conclusion
The results showed that propofol provided a greater antioxidant effect and reduced
SIRS postoperatively more than sevoflurane in children with CCHD undergoing cardiac
surgery.
Key Words
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References
- The volatile anesthetic sevoflurane inhibits activation of neutrophil granulocytes during simulated extracorporeal circulation.Int J Immunopharmacol. 2012; 14: 202-208
- Oxidative stress after surgery on the immature heart.Oxid Med Cell Longev. 2016; 20161971452
- Minimizing systemic inflammation during cardiopulmonary bypass in the pediatric population.Artif Organs. 2014; 38: 11-18
- Elevated circulating levels of inflammatory cytokines and bacterial endotoxin in adults with congenital heart disease.Am J Cardiol. 2003; 92: 188-193
- Inflammatory cytokines, apoptotic, tissue injury and remodeling biomarkers in children with congenital heart disease.Indian J Clin Biochem. 2014; 29: 145-149
- Effect of sevoflurane on the ex vivo secretion of TNF-α during and after coronary artery bypass surgery.Eur J Anaesth. 2003; 20: 380-384
- Anti-inflammatory effects of propofol during cardiopulmonary bypass: A pilot study.Ann Card Anaesth. 2015; 18: 495-501
- Metabolic and oxidative effects of sevoflurane and propofol in children undergoing surgery for congenital heart disease.Acta Cir Bras. 2011; 26: 66-71
- Role of sevoflurane in organ protection during cardiac surgery in children: A randomized controlled trial.Interact Cardiovasc Thorac Surg. 2015; 20: 157-165
- Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass.Pediatr Crit Care Med. 2010; 11: 234-238
- Consensus-based method for risk adjustment for surgery for congenital heart disease.J Thorac Cardiovasc Surg. 2002; 123: 110-118
- International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.Pediatr Crit Care Med. 2005; 6: 2-8
- Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial.J Clin Anesth. 2017; 38: 165-171
- Prevalence and clinical impact of systemic inflammatory reaction after cardiac surgery.J Cardiothorac Vasc Anesth. 2019; 33: 1682-1690
- The effects of sevoflurane on systemic and pulmonary inflammatory responses after cardiopulmonary bypass.J Cardiothorac Vasc Anesth. 2009; 23: 639-645
- Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass.BMC Anesthesiol. 2017; 17: 37
- Detrimental effects of cardiopulmonary bypass in cyanotic infants: Preventing the reoxygenation injury.Ann Thorac Surg. 1997; 64 (discussion 1387-8): 1381-1387
- Myocardial oxidative stress protection by sevoflurane vs. propofol: A randomised controlled study in patients undergoing off-pump coronary artery bypass graft surgery.Eur J Anaesthesiol. 2011; 28: 874-881
- Reactive oxygen species mediate sevoflurane- and desflurane-induced preconditioning in isolated human right atria in vitro.Anesth Analg. 2007; 105: 1534-1539
- Preconditioning in immature rabbit hearts role of KATP channels.Circulation. 1999; 99: 1249-1254
- The influence of propofol versus sevoflurane anesthesia on outcome in 10,535 cardiac surgical procedures.J Cardiothorac Vasc Anesth. 2007; 21: 664-671
- Sevoflurane downregulates interleukin-6 and interleukin-8 levels in patients after cardiopulmonary bypass surgery: A meta-analysis.Genet Mol Res. 2015; 14: 19016-19027
- Inflammatory response and cardioprotection during open-heart surgery: The importance of anaesthetics.Br J Pharmacol. 2008; 153: 21-33
Article info
Publication history
Published online: September 30, 2022
Footnotes
This study was funded by Çukurova University Scientific Research Projects Department. Grant number: 12411
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
