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Lack of lipolytic response in infants after endotracheal intubation
C Marcus1, H Selldén, E Rickardsson
1Department of Paediatrics, Huddinge University Hospital, Sweden.
Insights
Infants and adults exhibit similar circulatory responses to endotracheal intubation. However, unlike adults, infants do not show increased lipolysis, suggesting limited catecholamine-induced fat breakdown in infancy.
Area of Science:
- Physiology
- Pediatrics
- Anesthesiology
Background:
- Endotracheal intubation triggers a sympathoadrenal response.
- Understanding age-related differences in this response is crucial for pediatric anesthesia.
Purpose of the Study:
- To compare the sympathoadrenal response to endotracheal intubation in infants and adults.
- To investigate age-specific differences in lipolysis following intubation.
Main Methods:
- Investigated nine infants (2-4 months) and eight adults (23-45 years) undergoing inguinal hernia repair.
- Monitored heart rate, diastolic blood pressure, abdominal skin microvascular blood flow, adipose tissue blood flow, and plasma glycerol concentrations before and after intubation.
Main Results:
- Both infants and adults showed significant increases in heart rate and diastolic blood pressure post-intubation.
- Microvascular blood flow decreased in abdominal skin and adipose tissue in both groups.
- Plasma glycerol levels increased in adults but not in infants, indicating differing lipolysis rates.
Conclusions:
- Infants and adults display comparable circulatory adjustments to endotracheal intubation.
- Adults exhibit increased lipolysis, while infants do not, suggesting impaired catecholamine-induced lipolysis in infancy.
Abstract:
The sympathoadrenal response to endotracheal intubation was investigated in nine infants 2-4 months old and in eight adults 23-45 years old at the start of inguinal hernia operations. In both infants and adults, heart rate and diastolic blood pressure increased significantly immediately after intubation. In both groups, moreover, there was a mean (SD) reduction in microvascular blood flow in the abdominal skin (infants -21 (14)%, adults -14 (7)%) and in the adipose tissue (infants -7 (4)%, adults -5 (4)%). However, the plasma glycerol concentration did not increase in the infants whereas it increased in the adults by 50 (12)%. In conclusion, infants and adults showed similar circulatory reactions during endotracheal intubation but the markedly increased lipolysis rate observed in adults was not seen in the infants. This may indicate that catecholamine induced lipolysis in vivo as well as in vitro is poor during infancy.