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[Protective efficacy of 3 anesthetic methods with reference to surgical stress in children]
1Service d'Anesthésie, Institut scientifique pour enfants G. Gaslini, Gênes, Italie.
Insights
Total intravenous anesthesia (TIVA) and epidural blocks offer better surgical stress protection in children than traditional anesthesia. These techniques, particularly epidural anesthesia, reduce hormonal stress responses during pediatric surgery.
Area of Science:
- Pediatric Anesthesiology
- Surgical Stress Response
- Endocrinology
Background:
- Surgical stress triggers hormonal and metabolic responses impacting patient outcomes.
- Identifying anesthetic techniques that mitigate these responses is crucial for pediatric surgical care.
Purpose of the Study:
- To compare the efficacy of different anesthetic techniques in blunting perioperative hormonal stress responses in children.
- To evaluate cortisol, prolactin, and beta-endorphin levels as indicators of surgical stress.
Main Methods:
- Thirty-six pediatric patients (3-10 years) undergoing prolonged subumbilical surgery were randomized into three groups.
- Group 1: Propofol/fentanyl induction, isoflurane maintenance.
- Group 2: Total Intravenous Anesthesia (TIVA) with propofol/fentanyl.
- Group 3: Propofol infusion with lumbar epidural block (bupivacaine).
Main Results:
- Significantly elevated cortisol, prolactin, and beta-endorphin levels were observed only in the isoflurane group (Group 1).
- No significant hormonal stress differences were found between TIVA (Group 2) and epidural anesthesia (Group 3).
- Group 3 (epidural) demonstrated superior early postoperative analgesia.
Conclusions:
- Total Intravenous Anesthesia (TIVA) and epidural anesthesia provide superior protection against surgical stress in pediatric patients compared to isoflurane.
- Epidural block, in particular, offers enhanced analgesia and stress mitigation for subumbilical surgeries in children.
Abstract:
Hormonal-metabolic stress responses have beyond doubt an effect on morbidity/mortality related to surgery. The present study med to determine which anaesthetic technique could afford the best protection in children, through analysis of the perioperative cortisol, prolactin and beta-endorphin plasma levels. Thirty-six young patients 3-10 years old, ASA I-II, scheduled for hypospadias or vesicoureteral reflux surgery of a duration > 60 min, were randomized into three groups (n = 12). Children of group I were given initially propofol and fentanyl then isoflurane 1%; group 2 received TIVA with propofol and fentanyl, group 3 received initially propofol then an epidural lumbar block with bupivacaine 0.25% (single shot) and continuous propofol i.v. infusion. Cortisol, prolactin and beta-endorphin levels increased significantly in group 1 only. No significant differences were observed between group 2 and 3. Early postoperative analgesia was better in group 3. These data suggest that TIVA and particularly epidural block could afford a better protection against the surgical stress in children submitted to subumbilical operations.