[Protective efficacy of 3 anesthetic methods with reference to surgical stress in children].
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.
Ivani
G
G
Service d'Anesthésie, Institut scientifique pour enfants G. Gaslini, Gênes, Italie.
Vaira
M
M
Fossa
S
S
Mattioli
G
G
Jasonni
V
V
Caffarena
P E
PE
Podestà
E
E
Parodi
E
E
Rossi
L
L
D000768:Anesthesia, General / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D011388:Prolactin / Q000097:blood; D013312:Stress, Physiological / Q000209:etiology / Q000517:prevention & control*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D001615:beta-Endorphin / Q000097:blood
D001615:beta-Endorphin; D011388:Prolactin; D006854:Hydrocortisone