Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response.
In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 micrograms/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon, molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the non-fentanyl than in the fentanyl group. The urinary 3-methylhistidine/creatinine ratios were significantly greater in the non-fentanyl group on the second and third postoperative days. Compared with the fentanyl group, the non-fentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.
D000768:Anesthesia, General / Q000379:methods*; D001786:Blood Glucose / Q000032:analysis; D002986:Clinical Trials as Topic; D003472:Curare / Q000008:administration & dosage; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D006728:Hormones / Q000097:blood; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007773:Lactates / Q000097:blood; D009609:Nitrous Oxide / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control; D011773:Pyruvates / Q000097:blood; D011897:Random Allocation; D013312:Stress, Physiological
D001786:Blood Glucose; D006728:Hormones; D007773:Lactates; D011773:Pyruvates; D003472:Curare; D009609:Nitrous Oxide; D005283:Fentanyl