This study compared two opioid pain medications - morphine and fentanyl - used during open-heart surgery in young children born with heart defects (congenital heart disease). During open-heart surgery, the heart is temporarily stopped to allow surgeons to repair the defect. This process can cause damage to the heart muscle due to reduced blood flow and its restoration, known as ischemia-reperfusion injury, which is one of the leading causes of complications in children undergoing heart surgery. Morphine is known to activate specific receptors in the heart that may help protect it against this type of injury - a process called pharmacological preconditioning. While fentanyl has largely replaced morphine in pediatric cardiac anesthesia over the years, emerging evidence suggests that morphine may have unique heart-protective properties that fentanyl lacks. The purpose of this study was to investigate whether morphine provides better heart muscle protection than fentanyl in children with non-cyanotic congenital heart disease undergoing elective open-heart surgery. The study also aimed to compare postoperative recovery, need for heart-supporting medications, and other clinical outcomes between the two groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
66
Patients received fentanyl 1.5 µg/kg intravenously at anesthesia induction, followed by 1.5 µg/kg before skin incision, with maintenance via continuous infusion at 1 µg/kg/h throughout surgery.
Patients received morphine 0.15 mg/kg intravenously at anesthesia induction, followed by 0.15 mg/kg before skin incision, with maintenance via continuous infusion at 0.1 mg/kg/h throughout surgery.
Baskent Universityy Ankara Hospital
Ankara, Turkey (Türkiye)
comparison of myocardial protection
-plasma malondialdehyde (ng/ml) levels
Time frame: -Venous blood samples were collected at three time points: before skin incision (malondialdehyde1), at the end of surgery (malondialdehyde2), 6 hour postoperatively (malondialdehyde3)
comparison of myocardial protection
plasma glutathione (ng/ml) levels
Time frame: Venous blood samples were collected at three time points: before skin incision (glutathione1), at the end of surgery (glutathione2), and 6 h postoperatively (glutathione3)
comparison of myocardial protection
echocardiographic parameters (left ventricular end-diastolic and end-systolic Z scores and EF (%))
Time frame: Transthoracic echocardiography (TTE) was performed before skin incision and at 6 hours postoperatively
secondary outcome
-inotrope and vasopressor requirements (mcg/kg/min)
Time frame: perioperatively
secondary outcome
mechanical ventilation duration (h)
Time frame: from end of the surgery up to extubation
Secondary Outcome
opioid and sedative requirements (mcg, mg)
Time frame: periprocedurally
Secondary Outcome
need for defibrillation (+/-)
Time frame: perioperatively
Secondary Outcome
protamine-related hypersensitivity reactions (+/-)
Time frame: perioperatively
Secondary Outcome
intensive care unit length of stay (day)
Time frame: periprocedurally
Secondary Outcome
hospital length of stay (day)
Time frame: periprocedurally
Secondary Outcome
30-day mortality rates (+/-)
Time frame: from surgery up to 30 days postoperatively
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