Effect of caudal block on stress responses in children.
BACKGROUND
The present study was performed during lower abdominal and genitourinary surgery, to assess the effects of caudal block on plasma cortisol, prolactin, insulin and glucose concentrations during and after surgery.


METHODS
Thirty male children aged 3-10 years who were scheduled for elective surgery, were selected for the study. The children were premedicated with oral midazolam 0.5 mg/kg. All children received induction with nitrous oxide in oxygen and sevoflurane. The children were randomly allocated into two groups: Group I, control group (n = 15) and group II, caudal group (n = 15). Anesthesia was maintained by face mask with the same agent in both groups. Caudal block was performed with 0.25% bupivacaine 2 mg/kg after induction of anesthesia in the caudal group. Blood samples were obtained after induction of anesthesia (T(0)) in order to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T(1)), and 60 min after the end of surgery (T(2)).


RESULTS
All of the basal values (T(0)) were within the normal ranges accepted by Meram Medical Faculty of Selcuk University for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T(1), compared with T(0) and T(2) values (P < 0.05). However glucose concentration was lower in the caudal group than in the control group at T(1) (P < 0.05). In both groups, prolactin concentration increased at T(1), compared with T(0) (P < 0.05). The mean plasma prolactin and cortisol concentration were lower in the caudal group than the control group at T(1) and T(2) (P < 0.05). The mean insulin concentration was lower in the caudal group than the control group at T(2) (P < 0.05).


CONCLUSIONS
These results indicate that caudal anesthesia suppresses the metabolic and endocrine responses to stress associated with lower abdominal and genitourinary surgery in children.
Tuncer
Sema
S
Department of Anesthesiology, Meram Medical Faculty, Selcuk University, Konya, Turkey. tuncersema@hotmail.com
Yosunkaya
Alper
A
Reisli
Ruhiye
R
Tavlan
Aybars
A
CICekci
Faruk
F
Otelcioglu
Seref
S
D000005:Abdomen / Q000601:surgery*; D000704:Analysis of Variance; D000763:Anesthesia, Caudal; D001786:Blood Glucose; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011388:Prolactin / Q000097:blood; D013312:Stress, Physiological / Q000097:blood / Q000517:prevention & control*; D013519:Urogenital Surgical Procedures
D001786:Blood Glucose; D007328:Insulin; D011388:Prolactin; D006854:Hydrocortisone