Desflurane confers neurologic protection for deep hypothermic circulatory arrest in newborn pigs.
BACKGROUND
Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), as used for infant heart surgery, carry a risk of ischemic neurologic injury. Volatile anesthetics have neuroprotective properties against both global and focal ischemia at normothermia. The authors examined the hemodynamic and neuroprotective effects of desflurane in a piglet CPB-DHCA model.


METHODS
Twenty piglets aged 5-10 days received a desflurane- (6-9% expired) or fentanyl-based anesthetic before and during CPB (before and after DHCA). DHCA lasted 90 min at 19 degrees C brain. Cardiovascular variables (heart rate, arterial pressure, blood gases, glucose, brain temperature) were monitored. On postoperative day 2, neurologic and histologic outcomes were determined.


RESULTS
Cardiovascular variables before, during, and after CPB were physiologically similar between groups. The desflurane group had better neurologic performance (P = 0.023) and greater postoperative weight gain (P = 0.04) than the fentanyl group. In neocortex, the desflurane group had less tissue damage (P = 0.0015) and fewer dead neurons (P = 0.0015) than the fentanyl group. Hippocampal tissue damage was less in the desflurane group (P = 0.05), but overall, neuronal cell counts in the CA1 sector of the right hippocampus were similar to those in the fentanyl group.


CONCLUSIONS
Desflurane-based anesthesia yields hemodynamics during CPB with DHCA that are similar to those with fentanyl-based anesthesia. However, desflurane-based anesthesia improves neurologic and histologic outcomes of CPB-DHCA in comparison with outcomes with fentanyl-based anesthesia.
Kurth
C D
CD
Department of Anesthesiology and Critical Care Medicine, The Joseph Stokes Jr. Research Institute, and The Children's Hospital of Philadelphia, Pennsylvania 19104, USA. kurth@email.chop.edu
Priestley
M
M
Watzman
H M
HM
McCann
J
J
Golden
J
J
D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D000818:Animals; D000831:Animals, Newborn; D001522:Behavior, Animal / Q000187:drug effects; D001921:Brain / Q000473:pathology; D002315:Cardiopulmonary Bypass; D000077335:Desflurane; D006323:Heart Arrest / Q000209:etiology / Q000517:prevention & control*; D006439:Hemodynamics / Q000187:drug effects; D007035:Hypothermia / Q000150:complications*; D007530:Isoflurane / Q000031:analogs & derivatives / Q000494:pharmacology*; D018696:Neuroprotective Agents; D013552:Swine; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018696:Neuroprotective Agents; D000077335:Desflurane; D007530:Isoflurane