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Catecholamine and endocrine response in children during halothane and enflurane anaesthesia for adenoidectomy
Insights
Halothane anesthesia in children undergoing adenoidectomy led to higher plasma catecholamines compared to enflurane. This increased sympathomimetic response may explain ventricular arrhythmias seen with halothane.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Adenoidectomy is a common pediatric surgical procedure.
- Anesthesia choice can impact physiological responses during surgery.
- Previous studies suggest halothane is associated with ventricular arrhythmias in this context.
Purpose of the Study:
- To compare plasma catecholamine, ACTH, and cortisol concentrations during halothane versus enflurane anesthesia in children undergoing adenoidectomy.
- To investigate the sympathomimetic response to different anesthetic agents in pediatric patients.
Main Methods:
- Plasma catecholamines, ACTH, and cortisol were measured in 28 children undergoing adenoidectomy.
- Children were randomized to receive either halothane or enflurane anesthesia, with or without intubation.
- Hormonal levels were assessed during undisturbed anesthesia and immediately after surgery.
Main Results:
- Plasma catecholamines were significantly higher with halothane than enflurane during undisturbed anesthesia.
- Post-surgery, catecholamines increased up to 300% in halothane groups, while remaining unchanged in enflurane groups.
- ACTH and cortisol levels increased similarly across all groups during the procedure.
Conclusions:
- Halothane anesthesia is associated with a greater increase in plasma catecholamines compared to enflurane in children undergoing adenoidectomy.
- The heightened sympathomimetic response to halothane may contribute to the increased incidence of ventricular arrhythmias observed with this agent.
Abstract:
In 28 children undergoing adenoidectomy, plasma concentrations of catecholamines, ACTH and cortisol were measured. Fourteen children were anaesthetized with halothane (seven non-intubated, seven intubated) and 14 with enflurane (seven non-intubated, seven intubated). During undisturbed anaesthesia, plasma catecholamines were significantly higher with halothane than with enflurane (P less than 0.05). Immediately after surgery, catecholamines were increased up to 300% in the halothane groups. In the enflurane groups, however, the catecholamine concentrations remained unchanged. This difference between the two agents, after surgery, was statistically significant (P less than 0.01 for intubated and P less than 0.001 for non-intubated children). Fifteen minutes postoperatively no difference was found in plasma concentrations between the groups. In all four groups, plasma concentrations of ACTH and cortisol increased similarly during the procedure. It was concluded that plasma catecholamines were higher during halothane than during enflurane anaesthesia in children undergoing adenoidectomy. This difference may be caused by a stimulating effect of halothane on the endogenous catecholamine release. This increased sympathomimetic response during halothane anaesthesia was correlated to the incidence of ventricular arrhythmias previously found with this agent during adenoidectomy.