Cardioprotective effect of ketamine-dexmeditomidine versus fentanyl-midazolam in open heart surgery in pediatrics: a randomized controlled double blinded study

Background
Myocardial injury can occur during reperfusion of the heart during open heart surgery when the myocardium has been subjected to global ischemic cardioplegic arrest. The most common cardiac biomarker, cardiac troponin I (cTnI), can be used to assess the clinical prognosis of patients undergoing cardiac surgery. Anaesthetic medications have been linked to preventing ischaemia and reperfusion injury to the heart.
Methods
Eighty one children scheduled for open heart surgery were randomly divided into 3 groups Control group (C) (=27): Isoflurane 1.2MAC was used to maintain anaesthesia Ketamine-dexmedetomidine group (=27) KD Following the establishment of anaesthesia, dexmedetomidine (1 ug/kg) was administered over 10 minutes, followed by ketamine (2 mg/kg). maintenance throughout the operation was accomplished by administering ketamine (1 mg/kg/hr) and dexmedetomidine (0.5u g/kg/hr) while keeping variations in the mean arterial blood pressure to within 25% of the baseline. Fentanyl-midazolam group: (=27) FM: Fentanyl (3 ug/kg) and midazolam (100 ug/kg over 2 to 3 minutes) were used to induce anaesthesia, and midazolam (1 ug/kg/min) and fentanyl (2u g/kg/h) were used to maintain anaesthesia during the procedure. a baseline sample for troponin was taken (T0), and measurements were made at declamping, 1hr, 6hrs, 12hrs, and 24hrs after declamping. heart rate (HR) and mean arterial pressure (MBP) readings taken at baseline, induction, at skin incision, 15, 30 min, post bypass at15, 30, 45, 60 min, duration of CPB and number of patients required inotropic support and nitroglycerine. extubation time and ICU stay were also recorded.
Results
Troponin level was significantly lower in the KD group at declamping, 1, 6, 12, and 24 hr after declamping compared to FM and C group (<0.001). Extubation time was significantly lower in KD and FM groups compared to C group ( value <0.001) and was insignificantly different between KD and FM groups. ICU stay was significantly lower in the KD group compared to FM and C groups ( value <0.001).
Conclusion
By detecting the least increase in troponin I in paediatric patients undergoing elective congenital open heart surgery, the combination of ketamine and dexmeditomidine exerts great potential for cardiac protection and improving post-operative recovery compared to midazolam and fentanyl or the control group