Mirilas P, Mentessidou A, Kontis E, Antypa E, Makedou A, Petropoulos A S
Aristotle University Medical School, 2nd Department of Pediatric Surgery, Thessaloniki, Greece.
Eur J Pediatr Surg. 2010 Mar;20(2):106-10. doi: 10.1055/s-0029-1243620. Epub 2010 Jan 18.
The endogenous opioid beta-endorphin is a known indicator of stress and pain. Opioid anesthesia during operation may prevent postoperative beta-endorphin hypersecretion. We examine the effect on serum beta-endorphin of both preoperative stress and stress of operation under opioids in neonates, infants and preschool children. In order to eliminate the effect of hospitalization anxiety we compared with inpatients of similar age with non-surgical disease.
We included 74 surgical patients (25 neonates, 24 infants, 25 preschool children), and 44 non-surgical inpatients (14 neonates, 12 infants, 18 preschool children). Anesthesia comprised propofol and fentanyl. In presence of pain after extubation, supplementary morphine was administered. Sera were taken preoperatively and 2 h postoperatively in surgical patients, and once in non-surgical patients. Beta-endorphin was tested using ELISA (ng/ml).
In all surgical patients beta-endorphin did not increase significantly after surgery. Neonates showed significantly elevated beta-endorphin preoperatively (mean+/-SD: 2.02+/-0.76) and postoperatively (2.07+/-0.90) compared to neonates with a non-surgical disease (1.05+/-0.34; p<0.005). In contrast, infants (preoperative values: 1.75+/-1.32, postoperative values: 2.00+/-1.83) did not differ from respective non-surgical inpatients (1.49+/-0.70). Before and after surgery, beta-endorphin was significantly elevated in preschool children (7.19+/-1.85, 6.42+/-1.31), as compared with neonates and infants (p<0.0005), and with preschool children with non-surgical disease (1.01+/-0.27; p<0.0005).
Fentanyl/propofol anesthesia, supplemented by postoperative morphine where necessary, protects from surgical stress and postoperative pain, as denoted by no postoperative increase of beta-endorphin in all age groups. Preschool children, who exhibit increased emotional perception, have explicitly high serum beta-endorphin before and after surgery. Preoperative preparation programs might be worthy in this age group. Neonates show a moderate but still significantly high response of beta-endorphin to stress, retained after operation. In contrast, infants tolerated stress better (not increased beta-endorphin pre- and post-operatively).
内源性阿片肽β-内啡肽是已知的应激和疼痛指标。手术期间的阿片类麻醉可能会预防术后β-内啡肽分泌过多。我们研究了术前应激以及新生儿、婴儿和学龄前儿童在阿片类药物作用下手术应激对血清β-内啡肽的影响。为了消除住院焦虑的影响，我们将其与患有非手术疾病的同龄住院患者进行了比较。
我们纳入了74例手术患者（25例新生儿、24例婴儿、25例学龄前儿童）和44例非手术住院患者（14例新生儿、12例婴儿、18例学龄前儿童）。麻醉采用丙泊酚和芬太尼。拔管后若存在疼痛，则给予补充吗啡。手术患者在术前和术后2小时采集血清，非手术患者采集一次血清。使用酶联免疫吸附测定法（ELISA，ng/ml）检测β-内啡肽。
所有手术患者术后β-内啡肽均未显著增加。与患有非手术疾病的新生儿（1.05±0.34；p<0.005）相比，手术新生儿术前（均值±标准差：2.02±0.76）和术后（2.07±0.90）的β-内啡肽显著升高。相比之下，婴儿（术前值：1.75±1.32，术后值：2.00±1.83）与相应的非手术住院患者（1.49±0.70）无差异。与新生儿和婴儿相比（p<0.0005），以及与患有非手术疾病的学龄前儿童相比（1.01±0.27；p<0.0005），学龄前儿童手术前后的β-内啡肽显著升高（7.19±1.85，6.42±1.31）。
芬太尼/丙泊酚麻醉在必要时辅以术后吗啡，可预防手术应激和术后疼痛，所有年龄组术后β-内啡肽均未增加即表明了这一点。情绪感知增强的学龄前儿童手术前后血清β-内啡肽明显升高。对于这个年龄组而言，术前准备方案可能是有价值的。新生儿对应激的β-内啡肽反应适度但仍显著升高，术后仍保留。相比之下，婴儿对应激的耐受性更好（术前和术后β-内啡肽均未增加）。
