Impact of anesthetic technique on troponin I levels in pediatric cardiac surgery: a randomized clinical trial
Impacto da técnica anestésica nos níveis de troponina I em cirurgia cardíaca pediátrica: um ensaio clínico randomizado
João Victor Galvão Barelli, David D. Araujo, Suely P. Zeferino, Gustavo M. Dantas, Filomena B. Galas
Abstract
Background
This study aimed to evaluate the effects of the inhalational anesthetic sevoflurane on postoperative myocardial injury and renal function in children under 2 years old with congenital heart disease (RACHS 1, 2, and 3) undergoing cardiac surgery with extracorporeal circulation.
Methods
A randomized clinical trial was conducted with 66 patients divided into two groups: one receiving sevoflurane and the other Total Intravenous Anesthesia (TIVA). The primary outcome was the serum troponin I levels within the first 48 hours postoperatively. Secondary outcomes included urine output and serum urea levels.
Results
The median troponin I levels at 48 hours were 10.5 ng.mL−1 (IQR: 8.2–12.7) in the sevoflurane group and 11.0 ng.mL−1 (IQR: 8.7–13.0) in the TIVA group (p = 0.336). The sevoflurane group showed higher urine output on the second postoperative day (median: 800 mL [IQR: 420–913] vs. 541 mL [IQR: 312–718], p = 0.034) and lower serum urea levels (median: 24 mg.dL−1 [IQR: 16–35] vs. 36 mg.dL−1 [IQR: 23–49], p = 0.030).
Conclusions
While sevoflurane did not significantly impact myocardial injury markers, it demonstrated potential renal protective effects in this patient population. Further research is necessary to confirm these findings across different pediatric age groups and surgical contexts.
Keywords
Resumo
Introdução
Este estudo teve como objetivo avaliar os efeitos do anestésico inalatório sevoflurano sobre a lesão miocárdica pós-operatória e a função renal em crianças menores de 2 anos com cardiopatia congênita (RACHS 1, 2 e 3) submetidas à cirurgia cardíaca com circulação extracorpórea.
Métodos
Trata-se de um ensaio clínico randomizado com 66 pacientes divididos em dois grupos: um recebendo sevoflurano e o outro Anestesia Total Intravenosa (TIVA). O desfecho primário foi o nível sérico de troponina I nas primeiras 48 horas após a cirurgia. Os desfechos secundários incluíram diurese e níveis séricos de ureia.
Resultados
A mediana dos níveis de troponina I em 48 horas foi de 10,5 ng·mL⁻¹ (IQR: 8,2–12,7) no grupo sevoflurano e de 11,0 ng·mL⁻¹ (IQR: 8,7–13,0) no grupo TIVA (p = 0,336). O grupo sevoflurano apresentou maior diurese no segundo dia pós-operatório (mediana: 800 mL [IQR: 420–913] vs. 541 mL [IQR: 312–718], p = 0,034) e menores níveis séricos de ureia (mediana: 24 mg·dL⁻¹ [IQR: 16–35] vs. 36 mg·dL⁻¹ [IQR: 23–49], p = 0,030).
Conclusão
Embora o sevoflurano não tenha impactado significativamente os marcadores de lesão miocárdica, demonstrou potencial efeito protetor renal nessa população pediátrica. Mais estudos são necessários para confirmar esses achados em diferentes faixas etárias e contextos cirúrgicos.
Palavras-chave
Referencias
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Submitted date:
14/09/2024
Accepted date:
20/02/2025
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