J Cardiothorac Vasc Anesth. 2025 Oct 9:S1053-0770(25)01008-0. doi: 10.1053/j.jvca.2025.09.238. Online ahead of print.
ABSTRACT
OBJECTIVES: To compare the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on systemic inflammation and early postoperative cognitive recovery in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
DESIGN: Prospective, randomized controlled trial.
SETTING: A tertiary care center specializing in pediatric cardiac surgery.
PARTICIPANTS: Fifty children aged 1 to 12 years undergoing elective open heart surgery requiring cardiopulmonary bypass.
INTERVENTIONS: Participants were randomized to receive either propofol-based TIVA or sevoflurane-based volatile anesthesia. All patients were managed under standardized protocols for intraoperative monitoring and postoperative intensive care unit care.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the interleukin-6 concentration measured at baseline, 6 hours, and 24 hours postoperatively. Interleukin-6 levels increased significantly in both groups but showed no difference between groups at any time point. Secondary outcomes included Mini-Mental State Examination (MMSE) scores and duration of mechanical ventilation. Cognitive recovery was assessed in 34 children aged 4 years and older using a pediatric-adapted MMSE. At 24 hours post extubation, the mean MMSE scores were significantly higher in the TIVA group (23.7 ± 2.1) than in the volatile group (15.1 ± 3.0; p < 0.01), and the difference persisted at 48 hours (27.2 ± 1.4 vs 23.6 ± 2.8; p < 0.05). Ventilation duration was also shorter in the TIVA group (12.4 ± 3.2 hours vs 20.0 ± 4.6 hours; p = 0.045).
CONCLUSIONS: Interleukin-6 responses, the primary outcome, were comparable between groups. However, TIVA was associated with higher early MMSE scores and shorter ventilation duration, suggesting potential neuroprotective benefits.
PMID:41176450 | DOI:10.1053/j.jvca.2025.09.238
