The Impact of Sevoflurane and Propofol Anesthesia on Cerebral Blood Flow in Pediatric Open Cardiac Surgery, a Comparative Randomized Study

Authors: Ahmed M Farid, Hani I Mohamed*, Sabry RA and Saher I Taman

DOI: 10.23880/accmj-16000165

Volume 4, Issue 4

Abstract

Despite improvements in open cardiac surgical techniques and implementation of effective neuroprotective strategies, the brain, an organ highly sensitive to hypoxia, is still threatened by thromboembolic ischemic stroke, hemorrhage, or inflammation during CPB. Cerebral air embolization and hypoperfusion are considered as fundamental causes for these neurological complications. Transcranial Doppler can determine any air emboli entering brain circulation intra-operatively. Together with cerebral oximetry, they can detect any harmful embolic events during open cardiac surgery. New models of neuroprotective strategies were implanted to ameliorate this problem including different anesthetic medications like propofol and sevoflurane. Methods: 100 patients who were planned for elective cardiac surgery were recruited in this study. Anesthesia was maintained with Propofol infusion at a rate of 150μg/Kg/min or sevoflurane 1 MAC. Transcranial Doppler sonography was used to monitor cerebral blood flow, and oxygenation with evaluation of their neurocognitive function using ages & stages questionnaire. Results: Cerebral blood flow maximum velocity was higher in seveoflurane group when compared to propofol group at insertion and removal of aortic cannula as well as on release of aortic cross clamp. Mean arterial pressure and mean velocity of middle cerebral blood flow were higher in sevoflurane group when compared with propofol group. Also velocity mean were lower in comparison to basal values in propofol group. ages & stages questionnaire score comparison between both groups was of no significant difference. Conclusion: in comparison to sevoflurane, propofol decrease the maximum cerebral blood flow velocity, mean cerebral blood flow velocity and MAP more than sevoflurane. Meanwhile, it has equivalent effect to sevoflurane regarding neurocognitive outcome.

Keywords: Neurological complications; Pediatric; Open cardiac surgery; Cognitive domains; Hypoperfusion; Embolization; Transcranial Doppler; Cerebral oximetry; Neuroprotective strategies; Pharmacological neuroprotective

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