The use of sevofluran as cardioprotector for newborns in transposition of the great arteries correction surgery with cardiopulmonary bypass
Objective. Evaluation of sevofluran cardioprotective effect in newborns' transposition of the great arteries (TGA) correction surgery with cardiopulmonary bypass (CPB) and drug-induced cold cardioplegia. Material and methods. The presented monocentric, prospective, randomized cohort research focused on 42 newborns, average age 6 ± 3,1 days. Group One included those who had been administered inhalation anesthesia (IA) ( n = 22) maintained through inhalation of sevoflurane in 2-2.5 vol.%, infusion of fentanyl, and rocuronium. During the main stage of surgical correction sevofluran was administered into the oxygenizing unit of the CPB pump at 1-2 vol.%. Group Two included those who had been administered total intravenous anesthesia (TIVA) ( n = 20) maintained with midazolam, fentanyl, rocuronium. We have selected this type of surgical operation for our research, since it is carried out on great vessels, inducing least possible mechanical damage on the myocardium. We evaluated sevofluran cardioprotective effect by measuring troponin I concentration. Results. All newborns sevofluran administered in all stages of surgery, showed lower levels of troponin I in the first 24 hours after the correction. Patients from Group One required lower dosage of cardiotonic drugs. Patients, who had been administered sevofluran and anesthetic, also manifested higher left ventricular ejection fraction. While the TIVA patients registered significantly longer periods of artificial respiration period and stay in intensive care unit. Conclusion. Administering sevofluran as cardioprotector in all stages of TGA correction surgery in newborns, is justified and results in ameliorating hemodynamic indicators in post-surgical period.