Total Intravenous Versus Volatile Anesthesia in Pediatric Cardiac Surgery: Inflammatory Response and Early Recovery Profiles.

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.