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Metabolic and endocrine responses to surgery during caudal analgesia in children
1Department of Anesthesiology, Miyazaki Medical College, Japan.
Insights
Caudal analgesia effectively reduces stress responses in children undergoing lower abdominal surgery. This method suppresses metabolic and endocrine changes compared to general anesthesia, indicating improved patient outcomes.
Area of Science:
- Pediatric Anesthesiology
- Surgical Stress Response
- Endocrinology
Background:
- Surgical procedures in children can elicit significant metabolic and endocrine stress responses.
- Understanding these responses is crucial for optimizing anesthetic and analgesic techniques.
- Previous studies have explored various anesthetic methods, but direct comparisons of their impact on stress markers are needed.
Purpose of the Study:
- To compare the effects of general anesthesia (nitrous oxide and halothane) versus caudal analgesia (mepivacaine) on metabolic and endocrine stress markers in children undergoing lower abdominal surgery.
- To evaluate the suppression of stress responses by caudal analgesia.
Main Methods:
- Plasma concentrations of glucose, lactate, epinephrine, norepinephrine, insulin, cortisol, and growth hormone were measured in 28 healthy children (3-6 years) before, during, and after surgery.
- Children received premedication and were divided into two groups: general anesthesia (n=14) or caudal analgesia (n=14).
Main Results:
- Plasma glucose, epinephrine, and norepinephrine decreased in the caudal analgesia group but remained unchanged in the general anesthesia group.
- Insulin and cortisol increased post-surgery in the general anesthesia group, while growth hormone increased during and after surgery.
- These hormonal responses were suppressed in the caudal analgesia group.
- Plasma lactate concentrations remained unchanged in both groups.
Conclusions:
- Caudal analgesia significantly suppresses the metabolic and endocrine responses to the stress of lower abdominal surgery in children.
- This suggests that caudal analgesia may provide a more favorable physiological profile compared to general anesthesia for this patient population and surgical procedure.
Abstract:
Plasma concentrations of glucose, lactate, epinephrine, norepinephrine, insulin, cortisol and growth hormone were measured in 28 healthy children, three to six years of age, before, during, and after lower abdominal surgery. The children received premedication with secobarbital, 6 mg.kg-1, pentazocine, 0.5 mg.kg-1, and atropine, 0.01 mg.kg-1 im. Fourteen children received general anaesthesia with nitrous oxide and halothane, and 14 others received caudal analgesia with 1.5% mepivacaine. Plasma glucose, epinephrine and norepinephrine concentrations remained unchanged in the general anaesthesia group, but decreased during and after surgery in the caudal analgesia group (P less than 0.05). During surgery, these concentrations were different between the two groups (P less than 0.05). Plasma insulin and cortisol concentrations increased after surgery (P less than 0.05), and growth hormone concentration increased during and after surgery in the general anaesthesia group (P less than 0.05), but the concentrations of these hormones remained unchanged during and after surgery in the caudal analgesia group. Plasma lactate concentrations were unchanged in both groups. These results indicate that caudal analgesia suppresses the metabolic and endocrine responses to stress associated with lower abdominal surgery in children.