Remote Preconditioning and Myocardial Protection

Assiut University91 enrolled

Overview

Remote ischemic preconditioning (RIPC) of the myocardium by limb ischemia/reperfusion may mitigate cardiac damage, but its interaction with the anesthetic regimen is unknown.

The investigators will test if RIPC will be associated with differential effects depending on background anesthesia. Specifically, the investigators hypothesized that RIPC during sevoflurane anesthesia attenuates myocardial injury in patients undergoing congenital cardiac defects repair surgery and that effects may be different during propofol anesthesia.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

Conditions

Congenital Heart Disease

Interventions

Sevoflurane plus remote ischemic preconditioningDRUG

Inhalational anesthesia (Sevoflurane) in addition to remote ischemic preconditioning

Total intravenous anesthesia plus remote ischemic preconditioningDRUG

Total intravenous anesthesia (propofol plus fentanyl) in addition to remote ischemic preconditioning

Eligibility

Sex: ALLMin age: 6 MonthsMax age: 12 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pediatric scheduled for cardiac surgery requiring the cardioplegic arrest and cardiopulmonary bypass Exclusion Criteria: * Previous cardiac surgery * Urgent or emergent cases * Patient with the following diseases diabetes mellitus ,hypertension ,renal failure, hepatic and pulmonary diseases

Locations (1)

Faculty of Medicine

Asyut, Egypt

Outcomes

Primary Outcomes

Troponin I levels

The investigators will obtain blood samples for troponin I level pre-Cardiopulmonary bypass, 6, 12 and 24 hours after the surgery. Troponin I levels, as a marker of myocardial ischemia, have been used in previous adult and pediatric studies on preconditioning.

Time frame: within first 24 hours after cardiac surgery

Secondary Outcomes

Highest inotropic score during the first 24 hours after cardiac surgery

Inotrope score is a useful predictor of morbidity and mortality in children who undergo heart surgery. The inotropic score is calculated as follows: 1 point is assigned for each mcg/kg/min of dopamine and dobutamine, and 10 points is assigned for each 0.1 mcg/kg/min of epinephrine, norepinephrine, and phenylephrine. Inotrope score is a useful predictor of morbidity and mortality in children who undergo heart surgery

Time frame: within first 24 hours after cardiac surgery

Mortality at 30 days

Proportion of patients who dies within 30 days of their surgical repair

Time frame: 30 days

Cardiac function

Cardiac rhythm on return if it will be sinus rhythm or return with ventricular fibrillation

Time frame: within first 24 hours of cardiac surgery

Data from ClinicalTrials.gov

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