Methods: The study involved 50 pediatric patients (29 boys, 21 girls; mean age 12.6±2 months; range 9 to 20 months) operated on for tetralogy of Fallot between January 2014 and November 2015. We randomly divided the children into two groups and started esmolol infusion as an intraoperative agent for one group (study group), and with normal saline infusion for the other (control group). We started the esmolol infusion with the induction of anesthesia (0.05 mg/kg/min) and, then, reduced the dose by half (0.025 mg/kg) during the cardiopulmonary bypass. We took blood samples for creatine kinase-MB, troponin I, and lactate 10 minutes after the tracheal intubation, five minutes before the cardiopulmonary bypass, five minutes after the cardiopulmonary bypass, at the end of the surgery, at the four hours postoperatively, and on the first postoperative day. We recorded the hemodynamic parameters.

Results: The levels of creatine kinase-MB, troponin I and lactate were found to be significantly higher in the control group than the study group (p<0.05). The mean arterial pressures did not differ between the groups; however, we found that the heart rate in the study group was significantly lower than the control group (p<0.05). We found lower inotropic scores in the study group (p<0.05).

Conclusion: In pediatric cardiac surgery, the use of intraoperative esmolol may be effective in protecting from myocardium damage. Using an intraoperative esmolol infusion including the cardiopulmonary bypass in children is safe and reduces the postoperative inotropic score.