neuropeptide-y and Heart-Defects--Congenital

Opioids are used routinely to eliminate the stress response in the pre-bypass phase of paediatric cardiac surgery. Remifentanil is a unique opioid allowing a rapidly titratable effect. No data are available regarding a suitable remifentanil dose regimen for obtunding stress and cardiovascular responses to such surgery.. We recruited 49 infants and children under 5 yr old who were randomized to receive one of four remifentanil infusion rates (0.25, 1.0, 2.5, or 5.0 micro g kg(-1) min(-1)). Blood samples were obtained at induction, pre-surgery, 5 min after opening the chest, and immediately pre-bypass. Whole blood glucose was measured at all time points while cortisol and neuropeptide Y (NPY) were measured in the first and last samples. Heart rate and arterial pressure were also recorded.. There was a significant increase in whole blood glucose 5 min after opening the chest and pre-bypass (P=0.009, P=0.002) in patients receiving remifentanil 0.25 micro g kg(-1) min(-1), but not in those receiving higher doses. Increased remifentanil dosage was associated with reduced plasma cortisol during surgery (P<0.001). Baseline NPY showed considerable variation and there was no association between pre-bypass NPY and remifentanil dose. There was a significantly higher heart rate at the pre-bypass stage of surgery in the remifentanil 0.25 micro g kg(-1) min(-1) group compared with higher doses (P=0.0006). Four out of five neonates with complex cardiac conditions showed severe bradycardia associated with remifentanil.. In infants and children under 5 yr, remifentanil infusions of 1.0 micro g kg(-1) min(-1) and greater can suppress the glucose increase and tachycardia associated with the pre-bypass phase of cardiac surgery, while 0.25 micro g kg(-1) min(-1) does not. Remifentanil should be used with caution in neonates with complex congenital heart disease.

Topics: Analgesics, Opioid; Blood Glucose; Blood Pressure; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Heart Defects, Congenital; Heart Rate; Humans; Hydrocortisone; Infant; Male; Neuropeptide Y; Piperidines; Prospective Studies; Remifentanil; Stress, Physiological

This study aims to explore the changes in endothelin-1 (ET-1), plasma neuropeptide Y, and calcitonin gene-related peptide (CGRP) in child patients before and after operation. A total of 80 child patients with congenital heart disease (CHD) complicated with pulmonary hypertension (PH) were enrolled and divided into control group (n = 40, conservative treatment for various reasons) and observation group (n = 40, active preoperative preparation and timely operative intervention) according to different treatments. There were positive correlations between systolic pulmonary arterial pressure (sPAP) and ET-1, plasma neuropeptide Y, while negative correlation between sPAP and CGRP. In conclusion, our data demonstrate that the levels of ET-1, plasma neuropeptide Y, and CGRP in PH-CHD were significantly changed after interventions, which provides new leads as alternative biomarkers to assess the efficacy of treatments against PH-CHD.

Topics: Calcitonin Gene-Related Peptide; Child; Child, Preschool; Endothelin-1; Female; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant; Male; Neuropeptide Y; Postoperative Period; Preoperative Period

Our objective was to assess the sympathoadrenal response in pediatric patients undergoing repair of congenital cardiac defects.. Plasma catecholamine (norepinephrine and epinephrine) and neuropeptide Y concentrations were quantified before and after cardiopulmonary bypass to assess the response to cardiopulmonary bypass. To determine the response to aortic occlusion, levels of plasma catecholamines and neuropeptide Y were measured at the time of and immediately after release of the aortic crossclamp.. During cardiopulmonary bypass, no significant change in levels of plasma norepinephrine (n = 43), epinephrine (n = 37), or neuropeptide Y (n = 46) was observed. Aortic occlusion induced a significant increase in plasma neuropeptide Y, but not in catecholamines. There was a greater increase in plasma neuropeptide Y in children older than age 1 year than in those younger than 1 year.. Plasma neuropeptide Y may be a useful marker of sympathetic nervous system activity. Children younger than age 1 year showed a lesser sympathetic response compared with the response in older children.

Topics: Adolescent; Adrenal Glands; Age Factors; Biomarkers; Body Temperature; Cardiopulmonary Bypass; Catecholamines; Child; Child, Preschool; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Neuropeptide Y; Sympathetic Nervous System