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[Influence of caudal anesthesia on the secretion of catecholamines in children]
Insights
Caudal anesthesia significantly reduced stress responses in children undergoing surgery. This method effectively blocked the increase in catecholamines, unlike halothane anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Surgical Stress Response
Background:
- Elective subumbilical surgery in children can elicit significant physiological stress responses.
- Understanding and mitigating the peroperative stress response is crucial for patient safety and recovery.
Purpose of the Study:
- To compare the effects of halothane anesthesia versus caudal anesthesia with bupivacaine on the catecholamine response in pediatric patients undergoing surgery.
- To evaluate the impact of different anesthetic techniques on hemodynamic and neuroendocrine responses during surgery.
Main Methods:
- Eighty-two pediatric patients (4 months to 14 years, ASA I) were randomized into two groups: halothane anesthesia (control) and caudal anesthesia with 0.25% bupivacaine.
- Peroperative measurements included heart rate, respiratory rate, blood pressure, and plasma levels of adrenaline and noradrenaline.
- Statistical analysis was performed to compare the responses between the two groups.
Main Results:
- The halothane anesthesia group showed significant increases in heart rate, respiratory rate, systolic blood pressure, and adrenaline levels.
- The caudal anesthesia group exhibited a less pronounced hemodynamic response and a significant decrease in both adrenaline and noradrenaline levels.
- Significant differences were observed between groups in heart rate, respiratory rate, noradrenaline, and adrenaline levels, with caudal anesthesia showing blunted responses.
Conclusions:
- Caudal anesthesia effectively blocks the catecholamine stress response in children undergoing minor abdominal surgery.
- Caudal anesthesia provides superior attenuation of the surgical stress response compared to halothane anesthesia in this pediatric population.
- This suggests caudal anesthesia is a valuable technique for managing perioperative stress in pediatric surgery.
Abstract:
Eighty-two children, class ASA I, between four months and 14 years of age, all undergoing elective subumbilical surgery, were randomly assigned to two groups: a control "halothane anesthesia" group (n = 35) and a 0.25% bupivacaine "caudal anaesthesia" group (n = 47). In the control group, there was a significant peroperative increase in heart rate, respiratory rate, systolic blood pressure and plasma adrenaline levels (p less than 0.05). There was no significant difference in the noradrenaline levels. In the "caudal anaesthesia" group, the haemodynamic response was less pronounced, this being concomitant with a decrease in adrenaline and noradrenaline levels (p less than 0.05 and p less than 0.001, respectively). During surgery, there were significant differences between the groups in heart rate, respiratory rate, noradrenaline levels (3 +/- 0,30 nmol X l-1 vs 1.68 +/- 0.18 nmol X l-1; p less than 0.001) and adrenaline levels (1.67 +/- 0,28 nmol X l-1 vs 0.78 +/- 0.08 nmol X l-1; p less than 0.01). It is concluded that the catecholamine response in children undergoing minor abdominal surgery has been blocked by caudal anaesthesia.