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Discovering Pain in Newborn Infants
1From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Anesthesiology
|June 25, 2019
Summary
Fentanyl anesthesia significantly reduced the stress response in preterm infants undergoing surgery. This approach may improve postoperative outcomes by mitigating major hormonal and metabolic changes.
Area of Science:
- Neonatal surgery
- Pediatric anesthesia
- Surgical stress response
Background:
- Preterm infants undergoing patent ductus arteriosus ligation experience significant surgical stress.
- Anesthetic regimens involving nitrous oxide and D-tubocurarine may not fully attenuate this stress response.
Observation:
- A randomized controlled trial compared fentanyl anesthesia with standard anesthesia (nitrous oxide and D-tubocurarine) in preterm infants.
- Hormonal levels (adrenaline, noradrenaline, glucagon, corticosterone, etc.), insulin/glucagon ratio, and blood glucose/lactate/pyruvate were measured.
- Urinary 3-methylhistidine/creatinine ratios were assessed postoperatively.
Findings:
- Fentanyl anesthesia significantly blunted major hormonal responses to surgery compared to non-fentanyl anesthesia.
- Metabolic derangements and circulatory complications were more frequent in the non-fentanyl group.
- Reduced urinary 3-methylhistidine/creatinine ratios in the fentanyl group suggest less muscle catabolism.
Implications:
- Fentanyl anesthesia effectively mitigates the stress response in preterm infants during surgery.
- Preventing surgical stress with fentanyl may lead to improved postoperative outcomes in neonates.
- This study highlights the importance of adequate analgesia and anesthesia in minimizing surgical stress in vulnerable preterm infants.
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