Desflurane confers neurologic protection for deep hypothermic circulatory arrest in newborn pigs

Background: Cardiopulmonary bypass (CPB) and deep hypothermic circulatory a rrest (DHCA), as used for infant heart surgery, carry a risk of ischemic ne urologic injury. Volatile anesthetics have neuroprotective properties again st both global and focal ischemia at normothermia. The authors examined the hemodynamic and neuroprotective effects of desflurane in a piglet CPB-DHCA model. Methods. Twenty piglets aged 5-10 days received a desflurane- (6-9% expired ) or fentanyl-based anesthetic before and during CPB (before and after DHCA ). DHCA lasted 90 min at 19 degreesC brain. Cardiovascular variables (heart rate, arterial pressure, blood gases, glucose, brain temperature) were mon itored. On postoperative day 2, neurologic and histologic outcomes were det ermined. Results: Cardiovascular variables before, during, and after CPB were physio logically similar between groups. The desflurane group had better neurologi c performance (P = 0.023) and greater postoperative weight gain (P = 0.04) than the fentanyl group. In neocortex, the desflurane group had less tissue damage (P = 0.0015) and fewer dead neurons (P = 0.0015) than the fentanyl group. Hippocampal tissue damage was less in the desflurane group (P = 0.05 ), but overall, neuronal cell counts in the CAI sector of the right hippoca mpus were similar to those in the fentanyl group. Conclusions. Desflurane-based anesthesia yields hemodynamics during CPB wit h DHCA that are similar to those with fentanyl-based anesthesia. However, d esflurane-based anesthesia improves neurologic and histologic outcomes of C PB-DHCA in comparison with outcomes with fentanyl-based anesthesia.