| BackgroundStudies on suppressing perioperative stress responses with general anesthesia combined with local anesthesia have demonstrated that epi-dural anesthesia, spinal anesthesia and regional anesthesia can suppress stress responses by blocking afferent neurological impulses from insults. Caudal block is easy and safe performance in clinic application to pediatric anesthesia. Murat has demonstrated that caudal block can eliminate the level of plasma Cortisol during pediatric lower abdominal surgery and considered that caudal block can depress the endocrine responses during the lower abdominal surgery.In order to assess the effect of caudal block on stress responses to upper abdominal surgery in children, we have measured the perioperative changes of plasma ACTH, COR, IL -6, CRP values, average artery blood pressure and heart rate.Methods16 children aged 0. 58 ~9. 0 year, ASA I ~ II ,weight <25kg , undergoing elective upper abdominal surgery were assigned in this study. The children were known without endocrine and neurological abnormalities and were randomly allocated to receive either generalanesthesia ( control group, n = 8) or general anesthesia combined with caudal block ( caudal group, n = 8 ) .Atropin 0. 015mg/kg was administration in intra - muscular as pre - medication. Anesthesia was induct with Propofol 2mg/kg and Vecuroniu0.1mg/kg and maintained with 1. 0% ~ 2. 0% Isoflurane according to clinical criteria. In caudal group caudal blocks was performed by same qualified anesthetist with 0. 3% Ropivacaine 1. 25ml/ kg after the induction of anesthesia. Anus relaxation was considered the onset sign of caudal block. Dermatomal analgesia levels were observed using pinprick after awake of general anesthesia. The patients' pain/discomfort were evaluated after anesthesia using OPS system. Post - operative pain/discomfort scales of awake children were evaluated by crying, groan, facial expression, posture and touch painful are-a. The pain score > 4 were considered in pain /discomfort and recorded the dose and the dermatomal levels of the caudal block. Blood samples were obtained and collected in pre - chilled tubes containing EDTA before induction of anesthesia, 5 min, 60 min after skin incision , at the end of surgery and 24 h after surgery. After centrifugation plasma samples were kept - 20℃ until assayed. Plasma ACTH, COR, IL - 6 , CRP level was determined using the chemiluminescent enzyme immnoassay.The quantitative data were expressed as the x ±sD of each group. The paired student ' t test and unpaired student ' t test was performed to compared data within group and between the groups, x2 test was used for comparisons of the incidence of OPS <4. P <0. 05 was considered statistically significant.ResultsThe children in the caudal group and control group were similar in age, weight, high and type of surgical procedures. There were no differences between the two groups in duration of surgery and anesthesia. The dose of 0. 3% Ropivacaine was 17. 7 ±7. 2ml in caudal block. The dermatomal anesthesia levels of the caudal block were at T5 in average. The MAP in the caudal group decreased at 60min after skin incision, whereas the MAP in control group increased significantly from baseline values at 5min after skin incision and the end of surgery. There were no significant differences between two groups in heart rate. The means of ACTH concentrations increased significantly from baseline values at 5min after skin incision and returned to baseline values at 24h after surgery in both groups. The COR and IL - 6 values were increased significantly from baseline at the end of surgery and 24h after the surgery in both groups. The CRP values were increased significantly from baseline at 24h after the surgery in both groups. There are no significant differences between two groups in ACTH, COR, IL -6 and CRP values . The percent of OPS <4 at end of the surgery in caudal groups was higher than the control groups.ConclusionIn the present study, it is shown that there are exces...
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