Stress indicators during general anesthesia with opioid analgesics in children
To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. Materials and methods: This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). Results: The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P = 0.939). Conclusion: Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.
Stress indicators during general anesthesia with opioid analgesics in children
To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. Materials and methods: This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). Results: The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P = 0.939). Conclusion: Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.
___
- Tomić V. Odgovor organizma na stres izazvan hirurškom traumom. In: Jović M. Priručnik vaskularne anestezije. Begrade, Serbia: Alta Nova; 2004. pp. 145–160 (in Serbian).
- Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109–117.
- Ahima RS, Flier JS. Leptin. Annu Rev Physiol 2000; 62: 413– 437.
- Charmandari E, Kino T, Souvatzoglou E, Chrousos GP. Pediatric stress: hormonal mediators and human development. Horm Res 2003; 59: 161–179.
- Wolfram W, Kreuer K. The place for short-acting opioids: special emphasis on remifentanil. Crit Care 2008; 12 (Suppl. 3): S5.
- Gommers D, Bakker J. Medications for analgesia and sedation in the intensive care unit: an overview. Crit Care 2008; 12 (Suppl. 3): S4.
- Aosasa S, Ono S, Mochizuki H, Tsujimoto H, Osada S, Takayama E, Seki S, Hiraide H. Activation of monocytes and endothelial cells depends on the severity of surgical stress. World J Surg 2000; 24: 10–16.
- Samartino M, Garra R, Sbaraglia F, De Riso M, Continolo N. Remifentanil in children. Paediatr Anaesth 2010; 20: 246–255.
- Demirbilek S, Ganida S, Aksoy N, Becerik C, Baysal Z. The effects of remifentanil and alfentanil-based total intravenous anesthesia (TIVA) on the endocrine response to the abdominal hysterectomy. J Clin Anesth 2004; 16: 358–363.
- Bell G, Dickson U, Arana A, Robinson D, Marshall C, Morton N. Remifentanil vs fentanyl/morphine for pain and stress control during pediatric cardiac surgery. Paediatr Anesth 2004; 14: 856–860.
- Weale NK, Rogers CA, Cooper R, Nolan J, Wolf AR. Effect of remifentanil infusion rate on stress response to the pre-bypass phase of paediatric cardiac surgery. Br J Anaesth 2004; 92: 187– 194.
- Srinivas R, Brown SD, Chang YF, Garcia-Fillion P, Adelson PD. Endocrine function in children acutely following severe traumatic brain injury. Childs Nerv Syst 2010; 26: 647–653.
- Buyukkocak U, Caglayan O, Cagatay D, Aydinuraz K, Saygun O, Kaya T, Agalar F. Similar effects of general and spinal anaesthesia on perioperative stress response in patients undergoing haemorrhoidectomy. Mediators Inflamm 2006; 1: 1–5.
- Ghizzoni L, Mastorakos G. Interactions of leptin, GH and cortisol in normal children. Ann N Y Acad Sci 2003; 997: 56– 63.
- Marana E, Scambia G, Colicci S, Maviglia R, Maussier ML, Marana R, Proietti R. Leptin and perioperative neuroendocrine stress response with two different anaesthetic techniques. Acta Anaesthesiol Scand 2008; 52: 541–546.
- Karayiannakis AJ, Asimakopoulos B, Efthimiadou A, Tsaroucha AK, Polychronidis A, Simopoulos C. Serum leptin levels and their response during laparoscopic and open cholecystectomy. Eur Cytokine Netw 2005; 16: 91–96.
- Modan-Moses D, Ehrlich S, Kanety H, Dagan O, Pariente C, Esrahi N, Lotan D, Vishne T, Barzilay Z, Paret G. Circulating leptin and the perioperative neuroendocrinological stress response after pediatric cardiac surgery. Crit Care Med 2001; 29: 2377–2382.
- Michalaki M, Vagenakis AG, Argentou M, Mylonas P, Kalfarentzos F, Kyriazopoulou V. Dissociation of thyrotropin and leptin secretion in acute surgical stress in severely obese patients. Obes Surg 2009; 19: 1424–1429.
- Cicek M, Koroglu S, Demirbilek H, Teksan H, Ersoy MO. Comparison of propofol-alfentanil and propofol-remifentanil anaesthesia in percutaneous nephrolithotripsy. Eur J Anaesthesiol 2005; 22: 683–688.
- Chanavaz C, Tirel O, Wodey E, Bansard JY, Senhadji L, Robert JC, Ecoffey C. Haemodynamic effects of remifentanil in children with and without intravenous atropine. An echocardiographic study. Br J Anaesth 2005; 94: 74–79.