The term "systemic inflammatory response syndrome" (SIRS) refers to a nonspecific systemic inflammatory process that is identified by clinical criteria. Because the patient's blood hits the non-biocompatible circuit, there is ischemia-reperfusion injury (IRI) and endothelial cell activation during cardiac surgery with cardiopulmonary bypass (CPB). Recent research suggests that sevoflurane's cytoprotective impact in several organs after cardiac surgery is linked to the reduction of inflammatory cytokines. 6 Similarly, propofol reduces inflammatory cytokine production and has an antioxidant impact on the myocardium through lowering IRI. In a recent study, researchers examined the anti-inflammatory and anti-oxidant effects of propofol and sevoflurane in children with CCHD who were having heart surgery with CPB.
Children aged 1 to 10 years were enrolled in this prospective, randomized, double-blind trial. Children were randomly assigned to either sevoflurane (group S) or propofol (group P) general anesthesia (group P). The incidence of SIRS was evaluated at the conclusion of the surgery as well as at the 6th, 12th, and 24th postoperative hours. Blood samples were taken four times: after anesthetic induction (T0), after the aortic cross clamp was released (T1), at the conclusion of the surgery (T2), and at the postoperative 24th hour (T3). The blood levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-), as well as the total antioxidant and oxidant status (TAS) were measured. At all occasions, SIRS was more prevalent in group S than in group P (p=0.020, p=0.036, p=0.004, p=0.008). There was no significant difference between the groups in the mean TNF-α and IL-6 levels at any time. The TAS level at T2 was higher in group P than group S (p=0.036). The serum TAS level increased at T2 compared with T0 in group P, but it decreased in group S (p=0.041).
According to research, propofol reduced SIRS and oxidative stress more effectively than sevoflurane did in children with CCHD having cardiac surgery with CPB. Sevoflurane and propofol, however, were equivalent in terms of clinical outcomes and serum IL-6 and TNF- concentrations. Similar to endogenous antioxidant vitamin E and other phenol-based antioxidants, propofol has a chemical structure. Its antioxidant effects, which are unrelated to ischemia preconditioning, include scavenging free radicals, boosting tissue antioxidant capacity, and inhibiting plasma membrane calcium channels. So it stands to reason that in children with CCHD, propofol would probably have a greater antioxidant impact than sevoflurane. The study was unable to show a difference in clinical outcomes across the study groups, though. Therefore, extensive and focused research is required to show how anesthetic drugs affect children with CCHD clinically.
Reference –
Karacaer, Feride, et al. "The Anti-Inflammatory and Anti-Oxidant Effects of Propofol and Sevoflurane in Children with Cyanotic Congenital Heart Disease." Journal of Cardiothoracic and Vascular Anesthesia, 2022, https://doi.org10.1053/j.jvca.2022.09.094
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