Protective Effect of Propofol and Its Relation to Postoperation Recovery in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Abstract

The aim of this study was to investigate the effect of propofol and its relation to postoperation recovery in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Twenty ASA class I-II children with congenital heart disease undergoing cardiac surgery were randomly allocated to a propofol group (n = 10) or a control group (n = 10). Blood samples were collected at five time points: before operation (T (0)), before the start of CPB (T (1)), 25 min after the aorta was cross-clamped (T (2)), 30 min after release of the aortic cross-clamp (T (3)), and 2 h after the cessation of CPB (T (4)). The myocardial samples were collected at the time of incubation into the right atrium before CPB and at 30 min after reperfusion. After CPB, propofol significantly suppressed the increase of the serum lactate dehydrogenase (LDH), creatine phosphokinase (CK), and interleukin-6 (IL-6) levels and the decrease of the serum superoxide dismutase (SOD) level. In addition, propofol inhibited the increase of myocardial nuclear factor-κB (NF-κB) expression and inflammatory cells infiltration after CPB. Furthermore, propofol significantly shortened the tracheal extubation time. In conclusion, propofol exerts a protective effect and improves postoperation recovery through its antioxidant and anti-inflammatory actions in children undergoing cardiac surgery with CPB.

Antioxidant Therapeutic Strategies for Cardiovascular Conditions Associated with Oxidative Stress

“…In children undergoing CPB for atrial septal defect and VSD repair, the use of propofol resulted in less extubation time after surgery, in addition to a higher serum SOD activity and a lower serum IL-6 concentration during CPB and after cross-clamp removal. Accordingly, less inflammatory cell infiltration and a lower NF-κB expression was observed in myocardial tissue after CPB [ 166 ]. In another study that included several complex congenital heart malformations in children, the use of propofol also resulted in lower IL-6, IL-8 and MDA serum concentrations and higher serum SOD activity after CPB [ 167 ].…”

Circulating microRNAs indicate cardioprotection by sevoflurane inhalation in patients undergoing off-pump coronary artery bypass surgery

“…Zaugg et al ( 30 ) found that propofol was able to cancel the cardioprotective effect of sevoflurane in a concentration-dependent manner. By contrast, certain other studies suggested the same protective effect for propofol ( 31 , 32 ). Therefore, it is not certain which of the two drugs is mainly responsible for cardioprotection.…”

Oxidative Stress after Surgery on the Immature Heart

“…The induction and maintenance anaesthetic agent, propofol, exerts antioxidant effects on the adult heart [ 4 ]. Xia et al [ 54 ] in a study on 20 children undergoing CPB demonstrated reduced expression of NF- κ B in the propofol group. As seen earlier, oxidative stress is associated with the activation of the NF- κ B transcriptional factor.…”