Hamid Ghaderi - Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Manouchehr Hekmat - Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Saina Motahedin - Department of Pediatrics, Ali-Asghar Children`s Hospital, Iran University of Medical Sciences, Tehran, Iran
Zahra Ansari Aval - Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mahmoud Beheshti Monfared - Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Alireza Omidi Farzin - Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Seyedeh Adeleh Mirjafari - Islamic Azad University, Pharmaceutical Sciences Branch, in Tehran, Iran
Hamed Askarpour - Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mandana Hekmat - Shahid Beheshti University of Medical sciences. Tehran, Iran
Mahya Hekmat - Hormozgan University of Medical Sciences, Bandar Abbas, Iran

BACKGROUND: There is still a controversy about the best method for preoperative skin preparation (skin cleaning).The main antiseptic solution used in the cardiac surgery room is Povidone Iodine (PI), which is used to prepare the area to be operated on.This study aimed to determine the urinary iodine level in children (newborns, infants, and toddlers) undergoing (open and closed) heart surgery, in whom preoperative skin preparation was performed using PI solution.Methods: This study was conducted over eight years on a total of ۲۱۲ children who underwent cardiac surgery. A form was developed for each patient in which all their details, condition, and type of surgery were recorded. A urine sample was taken after the patients were anesthetized and before they were painted with PI through the urinary catheter that had to be attached to them for the cardiac surgery. The patients were then prepped with PI and draped and the surgery was performed. Afterwards, the second and third urine samples were taken ۲۴ and ۴۸ hours after the surgery from the urine collection bag. The samples were transferred to polyethylene tubes with screw caps in a cold box at -۲۰ °C and sent to the iodine reference laboratory of the Endocrinology Research Center of Shahid Beheshti University. The samples were measured using the kinetic colorimetric reaction proposed by Sandell and Kolthoff after the acid digestion of urine.Results: total of ۲۱۲ patients (newborns, infants, toddlers) who underwent (open and closed) cardiac surgery entered the study, including ۱۰۴ (۴۹.۱%) males and ۱۰۸ (۵۰.۹%) females. The patients ranged in age from ۱ day to ۱۴ years (mean = ۱۶۸ months).The urinary iodine level was ۴۰.۶±۲۱.۹ μgr/dl in the first stage (pre-surgery),۲۰۴.۱±۹۲.۵ μgr/dl in the second stage (۲۴ hours’ post-surgery), and ۱۳۰.۳±۵۶.۲μgr/dl in the third stage (۴۸ hours’ post-surgery).Discussion: Urinary iodine levels increased dramatically after PI use, and the second-stage urinary iodine changes (۲۴ hours’ post-surgery) were in the excessive range according to the WHO classification, and they decreased gradually over the next ۲۴ hours, but did not reach normal levels until ۴۸ hours’ post-surgery. The difference between the samples was significant (P<۰.۰۵). The samples were also separately analyzed by age group (groupA:۰-۲ years and group B: ۲-۱۴ years), which showed that transcutaneous iodine absorption and urinary iodine excretion were high in both age group.Conclusion: In children, transcutaneous iodine absorption following preoperative skin preparation with PI (for cardiac surgery) is so high that its urinary excretion reaches an excessive level ۲۴ hours after surgery and remains higher than normal until ۴۸ hours’ post-surgery. Furthermore, the transcutaneous absorption of iodine is similar in the ۰-۲ and ۲-۱۴-year-old age groups, and the iodine level following its transcutaneous absorption isexcessive in both age groups.

Povidone Iodine, Skin Absorption, Cardiac Surgery, Pediatric, Urine Iodine Level