నైరూప్య

Optimising sevoflurane administration during paediatric cardiopulmonary bypass.

Alok Kumar, Gurpinder Singh Ghotra, Ratnesh Shukla, Shrishanth Murali K, Badal Parikh, Nikhil Tiwari, HR Ramamurthy

Objective: The cardio and renal protective effect of sevoflurane on patients undergoing cardiac surgery is well established. However, the literature on concentration of sevoflurane to be used during cardiopulmonary bypass is lacking. The primary objective is to assess the cardiac and renal effects on patients undergoing on-pump paediatric cardiac surgery under general anesthesia with two different sevoflurane concentrations (1 vs 2 v/v%). The secondary objective was to observe the effect of two different concentrations of sevoflurane administration on the outcome of paediatric cardiac surgery. Methodology: It is a prospective, randomized, parallel group trial conducted at a tertiary care hospital; a single institution. Fifty-six paediatric patients undergoing on-pump cardiac surgery at the tertiary cardiac surgical center for congenital heart surgeries were analysed in this study. 1% v/v sevoflurane was given to patients in group 1 and 2% v/v in group 2 during cardiopulmonary bypass. Blood samples were collected preoperatively (T0), 4-hr (T1), one (T2), and two (T3) days after surgery for the estimation of lactate, serum cardiac troponin I (cTnI), blood urea, serum creatinine and serum NGAL. Serial echocardiography, renal oxygen saturation values (renal NIRS) and laboratory data obtained were then correlated with the postoperative course and, complications in intensive care unit. Results: A total of 56 patients were analyzed. Postoperatively, serum cTnI and lactate levels were lower in the group 2 but the difference was not statistically significant (p=0.7). Similarly, renal NIRS and serum NGAL were similar with use of 2 v/v% sevoflurane in the postoperative period (p=0.3 and 0.8 respectively). No statistically significant findings were noted about hemodynamic parameters, mechanical ventilation duration and length of hospital stay. Conclusion: The cardiac and renal functions did not show improvement in with higher sevoflurane concentration when used during cardiopulmonary bypass in paediatric cardiac surgery.