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Neuraxial blockade reduces stress parameters during major orthopaedic paediatric surgery
104
Posters
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Pediatric RA
111. Ex premature infants undergoing inguinal herniotomy: is the timing right? Goel S, Tan GM, Ng A Email: [email protected] BEAMS Hospital, 13/A Bandstand Bldg, Kane Road, Bandra, Mumbai 400 050. India Ex premature infants are at high risk of apnea after surgery. We conducted a retrospective study of 101infants from the year 1997 to 2000 receiving either general or regional anesthesia for inguinal herniotomy. Among these 101 infants 72 (71.3%) received general anesthesia of which 3 had failure of regional anaesthesia and 29 (28.7%) received regional anaesthesia only. 4 (5.6%) patients of the general anesthesia group had more than 5 days post-operative stay in the hospital of which 3 required oxygen and 1 needed to be ventilated postoperatively while 1 (4.3%) in the regional anaesthesia group required oxygen therapy post-operatively. Among these 5 patients, 2 patients had apnoeic episodes postoperatively, which required oxygen therapy, 1 patient had apnoea during the surgical procedure and 2 patients were on oxygen therapy. There were 47 patients in the 24-30 weeks range of gestational age which 25 had regional and 22 had general anesthesia. There were 36 infants between 36-44 weeks and 38 between 44-52 weeks at the time of surgery of which 48 received general anaesthesia and 26 received regional anaesthesia. We conclude that despite prevailing beliefs we seem to perform more GA and though there is still an increased incidence of complications. But with careful selection of patient population, timing and optimization of patient, GA is still a safe option and when ever possible elective surgery should be delayed in infants 52 weeks or younger.
172. Neuraxial blockade reduces stress parameters during major orthopaedic paediatric surgery Konkaev A, Neruda B Email: [email protected] Scientific Institute of Traumatology and Orthopaedics (NIITO), Department of Anaesthesiology and Resuscitation Kazachstan Private Institute for Studies in Medicine Astana, 473021 Kazachstan D-54585 Esch, Germany Introduction: The aim of the prospective study was to evaluate the potential beneficial effects of epidural anaesthesia or analgesia in addition to general anaesthesia in infants undergoing major surgery. Patients and Methods: Prospectively, twenty children aged 3 to 14 years scheduled for major orthopaedic surgery (thoracoplasty, scoliosis, Chiari-operation) were assigned to 2 groups: Group I (control; n⫽7) had general anaesthesia (GA) (halothane/air/oxygen). Group II (n⫽13) received a single-shot epidural consisting of 2 % lidocaine (7-8 mg/kg) or 0.5 % marcaine (2-2.5 mg/kg) combined with morphine (0.1 mg/kg), respectively, under spontaneous ventilation or in addition to GA. Heart rate, blood pressure, central venous pressure, ECG and oxygen saturation were monitored. Plasma cortisol, insulin, immunoglobulin G (IgG) and blood sugar were measured at 4 different occasions: before surgery (T1); at the time of maximum intraoperative stress (T2); the first (T3), and 7th (T4) postoperative day. Results: Groups were not different in regard to age, weight, duration of anaesthesia (180 ⫾ 31 min), perioperative cardiovascular parameters and base lines values of cortisol, insulin, glucose and IgG. Cortisol as well as glucose rose in both groups at T2 (p ⬍0.05), but were significantly higher in group I when compared to II (p⬍0.05). Insulin concentrations in group I dropped at T2 but increased at T3 and T4; they were not elevated in group II except at T3 but significantly less than in I (p⬍0.05). IgG levels in group I dropped at T2 (p⬍0.05) and T3 (p⬍0.01) which was lower than in II (p⬍0.05), and were elevated in II at T4 (p⬍0.05). Postoperative analgesia lasted 18 to 22 hours in group II, while group I required supplemental pain killers 2 - 3 hours postoperatively. Discussion: The beneficial protective effect of additional neuraxial block is derived from a lesser increase in the stress parameters cortisol, insulin and glucose. These parameters are sensible indicators of surgically induced sympathetically mediated reactions which were not seen in the cardiovascular system. However, epidural analgesia did not suppress formation of IgG which must be regarded as another level of the protective action of epidural analgesia to counteract surgically induced stress.
References Gouyet I, Dubois MC, Murat I, Saint-Maurice C: Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children. Acta Anaesthesiol Scand 1993; 37(1):12-16.
Posters
•
Pediatric RA
111. Ex premature infants undergoing inguinal herniotomy: is the timing right? Goel S, Tan GM, Ng A Email: [email protected] BEAMS Hospital, 13/A Bandstand Bldg, Kane Road, Bandra, Mumbai 400 050. India Ex premature infants are at high risk of apnea after surgery. We conducted a retrospective study of 101infants from the year 1997 to 2000 receiving either general or regional anesthesia for inguinal herniotomy. Among these 101 infants 72 (71.3%) received general anesthesia of which 3 had failure of regional anaesthesia and 29 (28.7%) received regional anaesthesia only. 4 (5.6%) patients of the general anesthesia group had more than 5 days post-operative stay in the hospital of which 3 required oxygen and 1 needed to be ventilated postoperatively while 1 (4.3%) in the regional anaesthesia group required oxygen therapy post-operatively. Among these 5 patients, 2 patients had apnoeic episodes postoperatively, which required oxygen therapy, 1 patient had apnoea during the surgical procedure and 2 patients were on oxygen therapy. There were 47 patients in the 24-30 weeks range of gestational age which 25 had regional and 22 had general anesthesia. There were 36 infants between 36-44 weeks and 38 between 44-52 weeks at the time of surgery of which 48 received general anaesthesia and 26 received regional anaesthesia. We conclude that despite prevailing beliefs we seem to perform more GA and though there is still an increased incidence of complications. But with careful selection of patient population, timing and optimization of patient, GA is still a safe option and when ever possible elective surgery should be delayed in infants 52 weeks or younger.
172. Neuraxial blockade reduces stress parameters during major orthopaedic paediatric surgery Konkaev A, Neruda B Email: [email protected] Scientific Institute of Traumatology and Orthopaedics (NIITO), Department of Anaesthesiology and Resuscitation Kazachstan Private Institute for Studies in Medicine Astana, 473021 Kazachstan D-54585 Esch, Germany Introduction: The aim of the prospective study was to evaluate the potential beneficial effects of epidural anaesthesia or analgesia in addition to general anaesthesia in infants undergoing major surgery. Patients and Methods: Prospectively, twenty children aged 3 to 14 years scheduled for major orthopaedic surgery (thoracoplasty, scoliosis, Chiari-operation) were assigned to 2 groups: Group I (control; n⫽7) had general anaesthesia (GA) (halothane/air/oxygen). Group II (n⫽13) received a single-shot epidural consisting of 2 % lidocaine (7-8 mg/kg) or 0.5 % marcaine (2-2.5 mg/kg) combined with morphine (0.1 mg/kg), respectively, under spontaneous ventilation or in addition to GA. Heart rate, blood pressure, central venous pressure, ECG and oxygen saturation were monitored. Plasma cortisol, insulin, immunoglobulin G (IgG) and blood sugar were measured at 4 different occasions: before surgery (T1); at the time of maximum intraoperative stress (T2); the first (T3), and 7th (T4) postoperative day. Results: Groups were not different in regard to age, weight, duration of anaesthesia (180 ⫾ 31 min), perioperative cardiovascular parameters and base lines values of cortisol, insulin, glucose and IgG. Cortisol as well as glucose rose in both groups at T2 (p ⬍0.05), but were significantly higher in group I when compared to II (p⬍0.05). Insulin concentrations in group I dropped at T2 but increased at T3 and T4; they were not elevated in group II except at T3 but significantly less than in I (p⬍0.05). IgG levels in group I dropped at T2 (p⬍0.05) and T3 (p⬍0.01) which was lower than in II (p⬍0.05), and were elevated in II at T4 (p⬍0.05). Postoperative analgesia lasted 18 to 22 hours in group II, while group I required supplemental pain killers 2 - 3 hours postoperatively. Discussion: The beneficial protective effect of additional neuraxial block is derived from a lesser increase in the stress parameters cortisol, insulin and glucose. These parameters are sensible indicators of surgically induced sympathetically mediated reactions which were not seen in the cardiovascular system. However, epidural analgesia did not suppress formation of IgG which must be regarded as another level of the protective action of epidural analgesia to counteract surgically induced stress.
References Gouyet I, Dubois MC, Murat I, Saint-Maurice C: Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children. Acta Anaesthesiol Scand 1993; 37(1):12-16.