Ivani G, Vaira M, Fossa S, Mattioli G, Jasonni V, Caffarena P E, Podestà E, Parodi E, Rossi L
Service d'Anesthésie, Institut scientifique pour enfants G. Gaslini, Gênes, Italie.
Cah Anesthesiol. 1996;44(4):297-302.
Hormonal-metabolic stress responses have beyond doubt an effect on morbidity/mortality related to surgery. The present study med to determine which anaesthetic technique could afford the best protection in children, through analysis of the perioperative cortisol, prolactin and beta-endorphin plasma levels. Thirty-six young patients 3-10 years old, ASA I-II, scheduled for hypospadias or vesicoureteral reflux surgery of a duration > 60 min, were randomized into three groups (n = 12). Children of group I were given initially propofol and fentanyl then isoflurane 1%; group 2 received TIVA with propofol and fentanyl, group 3 received initially propofol then an epidural lumbar block with bupivacaine 0.25% (single shot) and continuous propofol i.v. infusion. Cortisol, prolactin and beta-endorphin levels increased significantly in group 1 only. No significant differences were observed between group 2 and 3. Early postoperative analgesia was better in group 3. These data suggest that TIVA and particularly epidural block could afford a better protection against the surgical stress in children submitted to subumbilical operations.
激素 - 代谢应激反应无疑会对手术相关的发病率/死亡率产生影响。本研究旨在通过分析围手术期血浆皮质醇、催乳素和β - 内啡肽水平，确定哪种麻醉技术能为儿童提供最佳保护。36例3 - 10岁、ASA I - II级、计划进行持续时间> 60分钟的尿道下裂或膀胱输尿管反流手术的年轻患者被随机分为三组（n = 12）。第一组儿童最初给予丙泊酚和芬太尼，然后给予1%异氟烷；第二组接受丙泊酚和芬太尼的全凭静脉麻醉（TIVA），第三组最初给予丙泊酚，然后给予0.25%布比卡因的硬膜外腰麻（单次注射）和持续静脉输注丙泊酚。仅第一组的皮质醇、催乳素和β - 内啡肽水平显著升高。第二组和第三组之间未观察到显著差异。第三组术后早期镇痛效果更好。这些数据表明，全凭静脉麻醉，尤其是硬膜外阻滞，对于接受脐下手术的儿童，能更好地抵御手术应激。
