Venet Théa, Pichot Vincent, Charier David, Scalabre Aurélien, Patural Hugues
Pediatric Intensive Care Unit, University Hospital of Saint-Étienne, Saint-Étienne, France.
EA SNA-EPIS Research Laboratory, Jean Monnet University of Saint-Etienne, Saint-Etienne, France.
Paediatr Anaesth. 2018 Oct;28(10):881-887. doi: 10.1111/pan.13468.
General anesthesia dramatically decreases the activity of the autonomic nervous system. Most of the hypnotic agents used to induce anesthesia inhibit sympathetic cardiovascular regulation and baroreflex control in a dose-dependent manner, lowering cardiac adaptability during the operation. The consequence of this effect in children during and after surgery has never been studied to date.
The aim of this study was to follow the variations in autonomic cardiac indices in children younger than 8 years old after general anesthesia (6-24 hours) in programmed surgery.
A prospective descriptive monocentric study of 44 children under 8 years old who underwent scheduled surgery at our hospital center (Saint-Étienne University Hospital, France) was performed between June 1, 2016 and November 1, 2016. Heart rate variability was monitored for 24 hours using Holter-ECG devices and the resulting data were interpreted using linear and nonlinear analyses.
Compared to baseline thresholds before surgery, all heart rate variability indices decreased dramatically during general anesthesia. After awakening, a slight reduction in sympathetic activity persisted 6 hours after surgery, but all measurements of sympathetic and parasympathetic activity had returned to baseline thresholds 12 hours after the operation. Twenty-four hours after surgery, some parameters had increased above the corresponding baseline levels.
Autonomic nervous function normalizes rapidly (within 12 hours) in prepubertal children. This study indicates that general anesthesia does not seem to increase the long-term risk of autonomic dysfunction in these patients.
全身麻醉会显著降低自主神经系统的活性。大多数用于诱导麻醉的催眠药物会以剂量依赖的方式抑制交感神经对心血管的调节和压力反射控制，降低手术期间的心脏适应性。迄今为止，尚未对儿童手术期间及术后这种效应的后果进行研究。
本研究的目的是追踪8岁以下儿童在计划性手术中接受全身麻醉（6 - 24小时）后自主心脏指标的变化。
2016年6月1日至2016年11月1日，在我们医院中心（法国圣艾蒂安大学医院）对44名8岁以下接受择期手术的儿童进行了一项前瞻性描述性单中心研究。使用动态心电图设备监测心率变异性24小时，并使用线性和非线性分析对所得数据进行解读。
与手术前的基线阈值相比，全身麻醉期间所有心率变异性指标均显著下降。苏醒后，交感神经活动在术后6小时仍有轻微降低，但交感神经和副交感神经活动的所有测量值在术后12小时均恢复到基线阈值。术后24小时，一些参数高于相应的基线水平。
青春期前儿童的自主神经功能迅速恢复正常（12小时内）。本研究表明，全身麻醉似乎不会增加这些患者自主神经功能障碍的长期风险。
