Comparative study between the effect of sevofluraneand ketamine–midazolam on the cardiac troponin I level and hemodynamic variables in pediatric therapeuticcardiac catheterization for pulmonic stenosis

Introduction Congenital pulmonary stenosis is considered one of the most common cardiac anomalies in pediatrics. Percutaneous balloon dilatation is one method for its treatment, but it is usually associated with an increase in the cardiac troponin level.Aims and objectivesThe study was carried out to compare between the effect of sevoflurane and ketamine– midazolam on the level of cardiac troponin I as a specific marker for myocardial injury in children before and after therapeutic cardiac catheterization for pulmonic stenosis.Patients and methodsForty patients, up to 13 years old, undergoing cardiac catheterization were divided randomly into two groups: sevoflurane group (Gs) and ketamin–midazolam group (Gk-m). The standardized protocol for cardiac catheterization was maintained for all the patients. Serum samples were withdrawn at the start of — and 6 h subsequent to — the procedure for analysis of cardiac troponin I. Hemodynamic and oxygenation parameters were recorded at induction, T10, T20, and T30 minutes after induction. After recovery, sedation was assessed using the Ramsay Sedation Score.ResultsHemodynamic parameters, mean arterial blood pressure, heart rate, and cardiac index were significantly increased in Gk-m as compared with its basal values and with Gs. The serum cardiac troponin I was significantly increased after the procedure in both groups as compared with its basal value before the procedure. The increase in the cardiac troponin I was significantly higher in Gk-m than Gs (P 0.001). The Ramsay Sedation Score showed a significant increase in Gk-m than Gs at all times postoperatively.ConclusionThe use of sevoflurane as an anesthetic regimen for pediatric therapeutic cardiac catheterization for pulmonic stenosis is superior to the ketamine–midazolam combination as it is associatedwith a lower troponin I level, less myocardial injury, and greater hemodynamic stability.