Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements. Results Demographic characteristics, cardiopulmonary bypass time, and aortic crossclamp time were comparable in the 2 groups. Time-related changes in troponin I and creatine kinase-MB were similar in both groups. Statistically significant differences were seen in total cardioplegia volume requirement ( p < 0.0001), number of cardioplegia doses given ( p < 0.0001), packed red cell volume usage during cardiopulmonary bypass ( p < 0.02), and time taken to restore spontaneous regular rhythm ( p < 0.0001). Vasoactive-inotropic scores on transfer to the intensive care unit ( p < 0.040) and at 24 h ( p < 0.030) were significantly lower in the del Nido group. Duration of mechanical ventilation, intensive care unit stay, and hospital stay were comparable in the 2 groups. Conclusions Our results show that del Nido cardioplegia solution is as safe as conventional blood cardioplegia. Moreover, it provides the benefits of reduced dose requirement, lower consumption of allogenic blood on cardiopulmonary bypass, quicker resumption of spontaneous regular cardiac rhythm, and less inotropic support requirement on transfer to the intensive care unit and at 24 h, compared to conventional blood cardioplegia.

This prospective randomized study aims to evaluate and compare the effects of isoflurane, sevoflurane and desflurane (study drugs) on left ventricular (LV) diastolic function in patients with impaired LV relaxation due to ischemic heart disease using transesophageal Doppler echocardiography. After approval of the local ethics committee and informed consent, 45 patients scheduled for coronary artery bypass grafting surgery were enrolled in the study. Patients were selected by a preoperative Transthoracic Echocardiographic diagnosis of impaired relaxation or Grade 1 Diastolic Dysfunction. They randomly received fentanyl and midazolam anesthesia with 1 MAC of isoflurane (n=16), sevoflurane (n=14) or desflurane (n=15). Hemodynamic parameters and TEE derived ventricular diastolic relaxation indices before and after the study drug administration were compared. LV filling pressures were kept constant throughout the study period to exclude the effect of the loading conditions on diastolic function. Four patients in the sevoflurane group and three in the desflurane group were excluded from the study, after baseline TEE examination revealed normal diastolic filling pattern. All the three study drugs significantly reduced the systemic vascular resistance index with a significant increase in cardiac index. Mean arterial pressure was reduced by all the drugs, although the decrease was not statistically significant. Hemodynamic changes were comparable between all the three groups. In terms of LV relaxation indices, all three agents led to a significant improvement in diastolic function. Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly accompanied by a significant decrease in deceleration time and isovolumetric relaxation time. The effect of all three agents on diastolic relaxation parameters was comparable. In conclusion , Isoflurane, sevoflurane and desflurane, do not appear to have a detrimental effect in patients with early diastolic dysfunction. On the contrary, these inhalational agents actually improve the LV relaxation. A significant reduction in afterload produced by these vapors can be a possible reason for these findings. The positive effect of these inhalational agents on LV relaxation can have a profound effect on the perioperative anesthetic management of patients with diastolic dysfunction.

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