• Dominique A Bettex, Patrick M Wanner, Marco Bosshart, Christian Balmer, Walter Knirsch, Hitendu Dave, Claudia Dillier, Christoph Bürki, Maja Hug, Burkhardt Seifert, Donat R Spahn, and Beatrice Beck-Schimmer.
• Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland dominique.bettex@usz.ch.
• Interact Cardiovasc Thorac Surg. 2015 Feb 1;20(2):157-65.

ObjectivesThe 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).MethodsIn 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.ResultsThere 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.ConclusionsSevoflurane 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.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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