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Does halothane anaesthesia decrease the metabolic and endocrine stress responses of newborn infants undergoing

K J Anand¹, W G Sippell, N M Schofield

¹Department of Anesthesia, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115.

British Medical Journal (Clinical Research Ed.)

|March 5, 1988

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Potent anesthesia like halothane in neonates reduces surgical stress responses and improves clinical stability. Unsupplemented nitrous oxide anesthesia in newborns leads to greater metabolic stress and instability.

Area of Science:

Anesthesiology
Neonatal care
Surgical outcomes

Background:

Concerns regarding anesthetic side effects in neonates have led to the use of unsupplemented nitrous oxide and oxygen with muscle relaxants.
The efficacy of this anesthetic regimen in neonates requires further investigation.

Purpose of the Study:

To compare the efficacy of anesthesia with nitrous oxide and curare alone versus anesthesia with halothane, nitrous oxide, and curare in neonates undergoing surgery.
To assess the impact of different anesthetic regimens on hormonal and metabolic stress responses in neonates.

Main Methods:

A randomized controlled trial involving 36 neonates undergoing surgery.
Comparison of hormonal (adrenaline, noradrenaline, cortisol, insulin, glucagon) and metabolic (glucose, ketone bodies, non-esterified fatty acids) parameters between two anesthetic groups.

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Measurement of urinary 3-methylhistidine to creatinine ratio and assessment of clinical stability.

Main Results:

Halothane anesthesia significantly reduced hormonal stress responses (adrenaline, noradrenaline, cortisol) and altered insulin/glucagon ratio compared to unsupplemented nitrous oxide.
Neonates receiving halothane showed decreased changes in glucose, ketone bodies, and non-esterified fatty acids.
Unsupplemented nitrous oxide anesthesia was associated with increased urinary 3-methylhistidine/creatinine ratio and greater clinical instability.

Conclusions:

Potent anesthesia, such as halothane, should be administered to neonates undergoing surgery unless contraindicated, as it mitigates stress responses.
Halothane anesthesia improves clinical stability in neonates during and after surgical procedures.
Unsupplemented nitrous oxide anesthesia in neonates increases metabolic stress and compromises clinical stability.