Effect of propofol and fentanyl on perioperative inflammatory changes in children undergoing open heart surgery

Objective To investigate the effect of propofol and fentanyl on inflammatory response to tissue injury in children undergoing open heart surgery with CPB and the possible mechanism. Methods Twenty HYHA class Ⅱ - Ⅲ children with congenital heart disease, aged 10 month-12yr, undergoing elective open heart surgery were randomly divided into two groups: group F in which anesthesia was maintained with high dose fentanyl (50-80μg· kg-1 ) and group FP in which anesthesia was maintained with propofol infusion (20mg·kg-1·h-1 ) and intermittent iv boluses of fentanyl ( 30μg·kg-1 ) . The patients were premedicated with intramuscular morphine 0.1mg·kg-1 and scopolamine 0.01mg·kg-1. Anesthesia was induced with midazolam 0.15mg·kg-1, fentanyl10μg·kg-1 and pancuronium 0. 1mg·kg-1 and maintained with high dose fentanyl (group F) or propofol infusion combined with low dose fentanyl (group FP) . The patients were mechanically ventilated and PET CO2 was maintained between 35-45 mm Hg. Left radial artery and right internal jugular vein were cannulated for MAP and CVP monitoring. ECG, SpO2 and PETCO2 were continuously monitored during operation. Blood samples were taken before operation (T0), after beginning of operation and before CPB (T1 ), 25min after aorta was cross-clamped .(T2), 30 min after released of aortic cross-clamp (T3), 2h after discontinuation of CPB (T4) and 24h after operation (T5) for determination of blood levels of cytokine (IL-2, IL-6, IL-10 and TNFa), serum NO level and activities of three enzymes (LDH, CK, and CK-MB). Results The activities of LDH, CK and CK-MD were significantly increased after CPB in all patients. Blood IL-2, IL-6 and IL-10 levels were significantly increased at T3 or T4 in group F. In group FP only IL-6 level was significantly increased at T4 but there was no significant change in IL-2 and IL-10 levels. There was no significant change in bloodTNTa level during and after operation in both groups. Tracheal extubation was significantly much earlier in group FP. Conclusion Our study shows that intravenous infusion of propofol combined with low dose fentanyl can reduced inflammatory response to open heart surgery with CPB in children and allows earlier recovery.