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[Pediatric anesthesia and stress response]
Insights
Intravenous fentanyl effectively prevented stress responses in children undergoing lower abdominal surgery. However, epidural anesthesia with lidocaine did not inhibit these responses, though it aided postoperative pain management.
Area of Science:
- Pediatric Anesthesiology
- Surgical Stress Response
- Pain Management
Background:
- Surgical procedures trigger significant hyperglycemic and adrenocortical responses in children.
- Understanding and mitigating these stress responses is crucial for pediatric surgical care.
Purpose of the Study:
- To investigate the impact of different anesthetic techniques on endocrine-metabolic responses to abdominal surgery in children.
- To evaluate the efficacy of intravenous fentanyl and epidural anesthesia in blunting surgical stress.
Main Methods:
- Four groups of children undergoing abdominal surgery were studied.
- Group F: Light general anesthesia with intravenous fentanyl.
- Groups L-E and T-E: Light general anesthesia with lumbar or thoracic epidural anesthesia (lidocaine).
- Group H: General anesthesia (halothane).
Main Results:
- Intravenous fentanyl (10-13 µg/kg) significantly inhibited hyperglycemic and adrenocortical responses.
- Lumbar and thoracic epidural anesthesia with lidocaine did not inhibit these stress responses.
- General anesthesia alone did not inhibit the responses.
Conclusions:
- Intravenous fentanyl is effective in preventing endocrine-metabolic stress responses during pediatric abdominal surgery.
- The concentration and volume of lidocaine may influence the effectiveness of epidural anesthesia.
- Combined general and epidural anesthesia offers excellent postoperative pain management.
Abstract:
The hyperglycemic and adrenocortical responses to upper and lower abdominal surgery were studied in four groups of children. In F group, lower abdominal surgery was performed under light general anesthesia (halothane 0.3-0.5% plus nitrous oxide and oxygen) combined with intravenous injections of fentanyl 10-13 micrograms.kg-1. In L-E group, lower abdominal surgery was performed under light general anesthesia combined with lumbar epidural anesthesia (intermittent injections of 1.0% lidocaine). In T-E group, upper abdominal surgery was performed under light general anesthesia combined with thoracic epidural anesthesia (intermittent injections of 1.0% lidocaine). In H group, lower abdominal surgery was performed under general anesthesia (halothane 1.0-1.5% plus nitrous oxide and oxygen). The hyperglycemic and adrenocortical responses were inhibited in F group, suggesting that intravenous injections of fentanyl 10-13 micrograms.kg-1 prevented the endocrine-metabolic response. On the other hand, in other three groups, those responses were not inhibited. Therefore we must consider the concentration and the volume of lidocaine in epidural groups. But general anesthesia combined with epidural anesthesia had a excellent effect on the postoperative pain management.