Comparative study between the effect of sevoflurane and ketamine-midazolam on the cardiac troponin I level and hemodynamic variables in pediatric therapeutic cardiac catheterization for pulmonic stenosis

Abstract EN

Congenital pulmonary stenosis is considered one of the most common cardiac anomalies in pediatrics.

Percutaneous balloon dilatation is one method for its treatment, but it is usually associated with an increase in the cardiac troponin level.

Aims and objectives The study was carried out to compare between the effect of sevofl urane and ketamine– midazolam on the level of cardiac troponin I as a specifi c marker for myocardial injury in children before and after therapeutic cardiac catheterization for pulmonic stenosis.

Patients and methods Forty patients, up to 13 years old, undergoing cardiac catheterization were divided randomly into two groups: sevofl urane group (Gs) and ketamin–midazolam group (Gk-m).

The standardized protocol for cardiac catheterization was maintained for all the patients.

Serum samples were withdrawn at the start of — and 6 h subsequent to — the procedure for analysis of cardiac troponin I.

Hemodynamic and oxygenation parameters were recorded at induction, T10, T20, and T30 minutes after induction.

After recovery, sedation was assessed using the Ramsay Sedation Score.

Results Hemodynamic parameters, mean arterial blood pressure, heart rate, and cardiac index were signifi cantly increased in Gk-m as compared with its basal values and with Gs.

The serum cardiac troponin I was signifi cantly increased after the procedure in both groups as compared with its basal value before the procedure.

The increase in the cardiac troponin I was signifi cantly higher in Gk-m than Gs (P < 0.001).

The Ramsay Sedation Score showed a signifi cant increase in Gk-m than Gs at all times postoperatively.

Conclusion The use of sevofl urane as an anesthetic regimen for pediatric therapeutic cardiac catheterization for pulmonic stenosis is superior to the ketamine–midazolam combination as it is associated with a lower troponin I level, less myocardial injury, and greater hemodynamic stability.