title: Role of sevoflurane in organ protection during cardiac surgery in children: a randomized controlled trial.
abstract: OBJECTIVE
  The protective effects of volatile anaesthetics against ischaemia-reperfusion injury have been shown in vitro, but clinical studies have yielded variable results. We hypothesized that, in children, sevoflurane provides superior cardioprotection after cardiac surgery on cardiopulmonary bypass (CPB) compared with totally intravenous anaesthesia (TIVA).
  
  
  METHODS
  In this randomized controlled, single-centre study, 60 children with cyanotic and acyanotic heart defects undergoing elective cardiac surgery under CPB (RACHS-1 1-3) were randomized to sevoflurane or TIVA (midazolam <6 months of age, propofol >6 months of age). The primary end-point was the postoperative peak cardiac troponin I/T (cTnI/T). Perioperative cardiac function (as determined by brain-type natriuretic peptide, echocardiography and postoperative vasopressor/inotrope requirements), short-term clinical outcomes (duration of intubation, intensive care unit and hospital length of stay), postoperative inflammatory profile, and pulmonary, renal and liver function were defined as secondary end-points. Analysis of variance was used for statistical analysis.
  
  
  RESULTS
  There was no statistically significant difference in postoperative peak troponin values or any of the secondary end-points. In the subgroup of acyanotic patients under 6 months, sevoflurane led to significantly lower postoperative troponin levels compared with midazolam [reduction of 54% (95% confidence interval 29-71%, P = 0.002)], without any differences in secondary outcome parameters.
  
  
  CONCLUSIONS
  Sevoflurane did not provide superior myocardial protection in our general paediatric cardiac surgical population. In children under 6 months, however, sevoflurane might be beneficial in comparison with midazolam. The conditioning effects of sevoflurane in specific paediatric subgroups need to be further investigated.
authors.affiliation: Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland dominique.bettex@usz.ch.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Bettex
authors.affiliation: Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Wanner
authors.affiliation: Department of Anaesthesiology, Hirslanden Clinic, Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Bosshart
authors.affiliation: Department of Cardiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Balmer
authors.affiliation: Department of Cardiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
authors.affiliation: Department of Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Hitendu
authors.initials: H
authors.lastname: Dave
authors.affiliation: Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Dillier
authors.affiliation: Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bürki
authors.affiliation: Department of Intensive Care Medicine, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Maja
authors.initials: M
authors.lastname: Hug
authors.affiliation: Division of Biostatistics, University Zurich, Institute for Social and Preventive Medicine, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.affiliation: Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Beck-Schimmer
mesh_terms: D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002675:Child, Preschool; D019610:Cytoprotection; D017558:Elective Surgical Procedures; D006801:Humans; D007223:Infant; D008738:Methyl Ethers / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D008738:Methyl Ethers; D014336:Troponin; D000077149:Sevoflurane; D008874:Midazolam; D015742:Propofol
keywords: Cardiac surgery in children; Organ protection; Preconditioning; Volatile anaesthetics