title: The efficacy of caudal dexmedetomidine on stress response and postoperative pain in pediatric cardiac surgery.
abstract: OBJECTIVE
  We studied efficacy of caudal dexmedetomidine (DEX) on attenuation of perioperative stress response and postoperative pain in pediatric patients undergoing cardiac surgery.
  
  
  METHODS
  Forty patients, (ASA II, III), 1-3-years old were randomly allocated into two groups; group BD received caudal bupivacaine 0.25%, 2.5 mg/kg and DEX 0.5 μg/kg and group BF received bupivacaine 2.5 mg/kg and fentanyl 1 μg/kg.
  
  
  RESULTS
  Serum cortisol and blood glucose levels increased in both groups but increases were significantly less in group BD. Poststernotomy cortisol level (ug/dl) was 55.3 ± 5.1 vs. 90.4 ± 6.5; after cardio-pulmonary bypass (CPB) 84.1 ± 6.2 vs. 153.1 ± 8.5; after operation 78.3 ± 8.1 vs. 150.2 ± 9.8. Poststernotomy blood glucose level (mg/dl) was 93.6 ± 7.2 vs. 125.6 ± 5.5; after CPB 115.3 ± 3.7 vs. 175.3 ± 10.4; and after operation 97.3 2 ± 3 vs. 162.2 ± 12. Heart rate and mean arterial pressure decreased significantly after caudal block in group BD relative to the baseline and compared with group BF ( P < 0.05). Group BD had lower pain scores at first hour 2 ± 0.7 vs. 3 ± 1.1 ( P = 0.04); second hour 1.9 ± 0.5 vs. 3.7 ± 0.8, ( P = 0.008); fourth hour 2.4 ± 0.8 vs. 4.3 ± 0.5 ( P = 0.03); and eighth hour 2.5 ± 0.5 vs. 4.2 ± 1.1 ( P = 0.03).
  
  
  CONCLUSIONS
  Caudal DEX attenuated stress response to surgical trauma and provided better postoperative analgesia.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Ain Shams University Hospitals, Abbassia, Cairo, Egypt.
authors.forename: Dalia Abdelhamid
authors.initials: DA
authors.lastname: Nasr
authors.forename: Hadeel Magdy
authors.initials: HM
authors.lastname: Abdelhamid
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000763:Anesthesia, Caudal; D001786:Blood Glucose / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007223:Infant; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000517:prevention & control*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D001786:Blood Glucose; D020927:Dexmedetomidine; D006854:Hydrocortisone