None listed
Conditions
Brief summary
Study Aim: Cardiopulmonary Bypass with high oxygen levels may expose cyanotic children to reoxygenation injury. The superoxide radicals that are formed as a result of molecular oxygen and inflammatory response on cardiopulmonary bypass can cause a decrease in the high–energy phosphates, structural and functional changes in biomolecules. Antioxidant defense mechanism is inadequate in the children that have chronic hypoxia. Therefore, to avoid damage reoxygenation, various methods have been developed to reduce the formation of free oxygen radicals. Our study tested the hypothesis of oxidant damage via free radical generation during cardiopulmonary bypass on cyanotic pediatric patients. Materials and Methods: Cyanotic pediatric Patients (Fallot tetralogy)(n=30) were randomized to two treatment arms of the study. Cardiopulmonary bypass was performed as normoxic (pO2: 80-150mmHg) in Group I (n=15) and hyperoxic (pO2:150-250 mmHg) in Group II(n=15). Malondialdehyde, Glutathione peroxidase, Glutathione reductase were measured. Results: This study demonstrates that Malondialdehyde and antioxidant enzyme levels are higher in cyanotic infants with hyperoxic cardiopulmonary bypass. Conclusion: Routine clinical methods of cardiopulmonary bypass with a hyperoxemic may increase the reoxygenation injury in cyanotic children. The reoxygenation injury can be reduced by using a novel and simple Cardiopulmonary bypass strategy of controlled reoxygenation.
Interventions
Thirty pediatric patients scheduled to undergo elective repair of cyanotic congenital heart diseases. Patient’s room air saturation is lower than %85. Patients’ ages differed from 6 months to 5 years (average 24, 22+/-17, 42 months). All patients were in stable condition. The study was approved by the Research Ethics Committee of institution. Patients with genetic syndromes, preoperative inotropic support and reoperative procedures were excluded from the study. The patients who were taken into
Thirty pediatric patients scheduled to undergo elective repair of cyanotic congenital heart diseases. Patient’s room air saturation is lower than %85. Patients’ ages differed from 6 months to 5 years (average 24, 22+/-17, 42 months). All patients were in stable condition. The study was approved by the Research Ethics Committee of institution. Patients with genetic syndromes, preoperative inotropic support and reoperative procedures were excluded from the study. The patients who were taken into the study were divided into two groups as controlled normoxic (n=15) (pO2:80-150 mmHg) (Group I), and hyperoxic (n=15) (pO2: 150-250 mmHg) (Group II). All operations were performed under CPB. The same anesthesia technique was used in both groups. CPB was initiated using standard Aortabicaval cannulation. Isothermic blood cardioplegia was administrated every 20 minutes during aortic cross clamping. Equal perfusion pressure was applied in operations. After anesthesia induction, FiO2 rate was applied as 21% in Group I, and it was applied as 50% in Group II. Arterial blood gas was seen every 15 min. intervals after CPB started. In Group I, PO2 rate in arterial blood gas was about 80-150 mmHg; and in Group II, it was about 150-250 mmHg. After the patients were taken into intensive care, ventilator settings were calibrated as Fi02 21% in Group I, and Fi02 50% in Group II; and routine intensive care protocols were applied. Patients’ MDA (Malondialdehit), GSH-Px (Glutathione Peroxidase), Glutathione reductase (GSH-R) rates were looked from the blood, which were drawn from the patients pre-operation (T1), during operation after CC in the 30th minute (T2), 10 minutes after aortic clamp was removed (T3) and 12th hours (T4). Also, measured values’ correlation with reference periods, pump duration, CC duration, extubation period and mortality rates was examined.
Sponsors
Cukurova University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
6 Months to 5 Years
Healthy volunteers
No
Inclusion criteria
Elective total correction of cyanotic congenital heart diseases
Exclusion criteria
Acyanotic congenital heart diseases
Outcome results
None listed