Spinal anesthesia with an indwelling catheter reduces the stress response in pediatric open heart surgery.
BACKGROUND
Extreme stress and inflammatory responses to open heart surgery are associated with increased morbidity and mortality. Based on both animal and adult human data, it was hypothesized that spinal anesthesia would be more effective at attenuating these responses than conventional high dose intravenous opioid techniques in infants and young children undergoing open heart surgery.


METHODS
A prospective randomized controlled clinical trial was performed in 60 children aged up to 24 months undergoing open heart surgery. Patients were randomly assigned to receive either high-dose intravenous opioid or high-dose intravenous opioid plus spinal anesthesia. Spinal anesthesia was administered via an indwelling intrathecal catheter.


RESULTS
Spinal anesthesia significantly reduced the stress responses as measured by plasma norepinephrine and epinephrine concentrations (both P < 0.05). Spinal anesthesia reduced plasma lactate concentrations (P < 0.05), but increased fluid requirements during the first postoperative day (P < 0.05). There were no differences in other cardiovascular parameters.


CONCLUSIONS
Continuous spinal anesthesia reduces stress responses in infants and young children undergoing cardiac surgery with cardiopulmonary bypass more effectively than high-dose intravenous opioids alone.
Humphreys
Nigel
N
Bristol Royal Hospital for Children, and Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
Bays
Simon M
SM
Parry
Andrew J
AJ
Pawade
Ashwinikumar
A
Heyderman
Robert S
RS
Wolf
Andrew R
AR
D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D000775:Anesthesia, Spinal / Q000009:adverse effects; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002395:Catecholamines / Q000378:metabolism; D002404:Catheterization / Q000009:adverse effects; D016207:Cytokines / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D008297:Male; D011446:Prospective Studies; D013312:Stress, Physiological / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015415:Biomarkers; D002395:Catecholamines; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; D019344:Lactic Acid; D006854:Hydrocortisone