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Metabolic and endocrine responses to surgery during caudal analgesia in children

  • Tadashi Nakamura
  • Mayumi Takasaki
Reports on Investigation
Accepted:

Abstract

Plasma concentrations of glucose, lactate, epinephrine, norepinephrine, insulin, cortisol and growth hormone were measured in 28 healthy children, three to six years of age, before, during, and after lower abdominal surgery. The children received premedication with secobarbital, 6 mg · kg−1, pentazocine, 0.5 mg · kg−1, and atropine, 0.01 mg · kg−1 im. Fourteen children received general anaesthesia with nitrous oxide and halothane, and 14 others received caudal analgesia with 1.5% mepivacaine. Plasma glucose, epinephrine and norepinephrine concentrations remained unchanged in the general anaesthesia group, but decreased during and after surgery in the caudal analgesia group (P < 0.05). During surgery, these concentrations were different between the two groups (P < 0.05). Plasma insulin and cortisol concentrations increased after surgery (P < 0.05), and growth hormone concentration increased during and after surgery in the general anaesthesia group (P < 0.05), but the concentrations of these hormones remained unchanged during and after surgery in the caudal analgesia group. Plasma lactate concentrations were unchanged in both groups. These results indicate that caudal analgesia suppresses the metabolic and endocrine responses to stress associated with lower abdominal surgery in children.

Key words

anaesthesia: paediatric anaesthetic techniques: caudal, epidural blood: glucose hormones: catecholamines, corticosteroid, growth, insulin 

Résumé

Des concentrations plasmatiques de glucose, lactate, épinéphrine et norépinéphrine, insuline, cortisole, et hormones de croissance ont été mesurées chez 28 enfants en bonne santé âgés de trois à six ans, avant, pendant et après une chirurgie abdominale basse. Les enfants ont reçu en prémédication du sécobarbital 6 mg · kg−1, du pentazocine 0,5 mg · kg−1 et de l’atropine 0,01 mg · kg−1 en injection intramusculaire. Quatorze enfants ont reçu de l’anesthésie générate avec du protoxyde d’azote et d’halotane, quatorze autres ont reçu de l’analgésie caudale avec 1,5% de mépivacaïne. Les concentrations plasmatiques de glucose, épinéphrine, et norépinéphrine n’ont pas changé dans le groupe d’anesthésie générale mais ont diminué pendant et après la chirurgie dans le groupe anesthésie caudale (P < 0,05). Lors de la chirurgie, les concentrations étaient différentes entre les deux groupes (P < 0,05). Les concentrations plasmatiques d’insuline et de cortisol ont augmenté après la chirurgie (P < 0,05), et les concentrations d’hormones de croissance ont augmenté durant et après la chirurgie dans le groupe anesthésie générate (P < 0,05), mais les concentrations de ces hormones n’ont pas changé durant et après l’anesthésie dans le groupe anesthésie caudale. Les concentrations plasmatiques de lactate n’ont pas changé dans les deux groupes. Ces résultats indiquent qu’une analgésie caudale supprime les réponses métaboliques et endocriniennes au stress associé à la chirurgie abdominale basse chez les enfants.

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Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • Tadashi Nakamura
    • 1
  • Mayumi Takasaki
    • 1
  1. 1.Department of AnesthesiologyMiyazaki Medical CollegeKiyotake, MiyazakiJapan

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