Effect Of General Anesthesia Combined With Thoracic Epidural Anesthesia On Stress Responses In Children Undergoing Upper Abdominal Surgery

The traditional opinion on pediatric analgesia is that children are not sensitive to the perioperative pain. But now we fond that the pediatric stress response is as same as adult's. Sometimes the pediatric perioperative stress response is stranger than the adult's stress response. The pediatric perioperative stress response is the result of the operative and anesthesia. A few resent studies approve that anesthesia is an important fact that affect perioperative stress response and immunological function. Different anaesthetic methods may put different effects on patient's cytokine and perioperative stress response. So, how to find a proper anaesthetic method to suppress the pediatric perioperative stress has been an important topic.Objective: To investigate the effects of the combination of general anesthesia and thoracic epidural anesthesia on responses in children undergoing upper abdominal surgery by measure the perioperative changes of the cortisol and interleukin-6 in serum, average artery blood pressure, heart rate and Pulse Oxygen Saturation.Methods: Thirty ASA gradeⅠ-Ⅱpatients with choledochal cyst undergoing choledochocystectomy were randomly assigned to two groups (n=15): groupⅠ, treated with the combination of general anesthesia and thoracic epidural anesthesia; groupⅡ, only treated with general anesthesia. All patients were known without endocrine and neurological abnormalities.Atropine 0.01-0.02mg/kg and Diazepam 0.2-0.3mg/kg were intramuscular injection 30 minutes before operation. Ketamine 5-7mg/kg were intramuscular injection before get into the operating room. The patients in groupⅠwerereceived epidural block (T9~10) , The patients were injected with1% lindocaine 1-3ml. After 5min the patients were injected with 0.25% 1mg/kg bupicaine if without poisoning. Then the patients in groupⅠwere received general anesthesia. General Anesthesia was induced by midazolam(0.1mg/kg), fentanyl(2~3μg/ml), vecuronium(0.1mg/kg), diprivan(2mg/kg) and then tracheal cannula was performed to sustain the respiration with respirotor. The patients in groupⅡwere treated as groupⅠexcept the epidural block.The perioperative average artery blood pressure, heart rate and Pulse Oxygen Saturation., the time of revival after operation ,the interval of adding drugs during operation were recorded. Post operative pain scales of awake children were evaluated by the modified objective pain scores (MOPS) system. Blood samples were obtained and collected in tubes before anesthesia, 5min, 60min after skin incision, at the end of surgery and 12h post operative. After centrifugation serum samples were kept -20℃until assayed. The levels of COR and IL-6 in serum were measured by radioimmunoassay.Results: The groups were similar in age, body weight, duration of surgery, and perioperative transfusion of fluid(P﹥0.05).①There was no significantly difference between groupⅠand groupⅡin preoperative MAP,HR and SpO2. In groupⅠ, MAP was significantly lower than preoperation at 5min after skin incision. In groupⅡ, the MAP and HR after skin incision were significantly higher than preoperation and that in groupⅠ. The changes of the HR in groupⅠwas not obviously at the time of tracheal cannula. The SpO2 in groupⅡwas significantly lower than groupⅠ.②In both groups, the serum levels of COR were significantly increased from 60min after skin incision then on. And there was significantly difference between groupⅠand groupⅡin the serum levelsof COR at 60min after skin incision and the end of surgery, but it was no significantly difference 12h post operative.③There was no significantly difference between groupⅠand groupⅡin the serum levels of IL-6. At the end of surgery, the serum levels of IL-6 were significantly increased in both groups. And there was significantly difference between groupⅠand groupⅡin the serum levels of IL-6 at the end of surgery, but it was no significantly difference 12h post operative.④There was significantly difference between groupⅠand groupⅡin the interval of adding fentanyl and vecuronium during operation, the time of revival and extubation.⑤After extubation and at 3h post operation, the MOPS scales in groupⅠwere significantly lower than groupⅡ.But there was no significantly difference at 12h post operative.Conclusions: The results suggest that the combination of general anesthesia and thoracic epidural anesthesia cannot absolutely suppressed the stress responses of COR and IL-6 during upper abdominal surgery in children. But the interference on circulation system and the stress responses in the combined anesthesia are slighter than those in general anesthesia. The method that combination of general anesthesia and thoracic epidural anesthesia is better than general anesthesia in children undergoing upper abdominal surgery.