Influence of intravenous sildenafil on cerebral oxygenation measured by near-infrared spectroscopy in infants after cardiac surgery

Sildenafil (Viagra) has been shown to be an effective pulmonary vasodilator and is increasingly used in patients with pulmonary hypertension. Its effects on the cerebral circulation are unclear and have not yet been described. We investigated the effect of i.v. sildenafil treatment on cerebral oxygenation in 13 children with elevated pulmonary vascular resistance due to congenital heart defects after cardiac surgery using near-infrared spectroscopy (NIRS). Median age was 4.5 mo, and median weight was 5.5 +/- 1.8 kg. Sildenafil was administered in three steps of 15 min each with cumulative doses of 0.025, 0.1, and 0.25 mg/kg. We examined the changes of oxygenated hemoglobin (HbO(2)), deoxygenated hemoglobin (HHb), total hemoglobin (tHb) concentration, cytochrome oxidase (CytOx) oxygenation. and cerebral tissue oxygenation index (TOI) in 13 children. A significant increase in cerebral HbO(2) and tHb at the beginning of i.v. sildenafil administration with a decrease in HHb was observed. These changes led to a significant elevation in cerebral TOI from 63.4 +/- 2.5% to 65.7 +/- 2.8%, whereas mean systemic arterial pressure and arterial oxygen partial pressure tended to decrease. In conclusion, we observed a reversible increase of HbO(2), tHb, and hemoglobin oxygen saturation in the scanned tissue section after i.v. sildenafil administration. These findings may be clinically relevant because they indicate that after cardiac surgery, sildenafil may increase cerebral blood flow (CBF), probably due to general endothelial dysfunction after cardiopulmonary bypass (CPB).