| Objectives: Inorder to find a suitable way of anesthesia to control the sress response during peri-operation, the effects of different anesthesia on stress response and serum interleukin level were compared in pediatric patients undergoing Laparoscopic surgery either under general anesthesia alone(GA) or general anesthesia combined with epidural anesthesia (GEA) by measuring serum concentrations of inephrine, nonepinephrine, L-6, IL-10 and hemodynamics at different stages of peri-operation.Methods:40 pediatric patients with average age of 2.05±0.73 years old and body weight of 12.56±4.23kg prepared to do Laparoscopic surgery were randomly assigned into GA group ( group A,n=20) and GEA group ( Group B,n=20). All the patients were premedicated with sodium luminal (5mg/kg) and atropine(0.01mg/kg) 30 minutes prior operation. Patients in group B were punctured into epidural space though T11-12, and 2 cm long tube was inserted after the patients were sent to the operating room, then 1.2% lidocaine was administered. Midazolam(0.1mg/kg), Fentany(l5μg/kg), Propofol 2mg/kg, and vecuronium(0.1mg/kg) were used for the induction of anesthesia in both groups. Ohmeda S/5 was used to control respiration after intubation. Anesthesia was maintained with intravenous Propofol , Fentanyl and vecuronium. 1.2% lidocaine was added every 45 min in Group B. HR,MAP,ECG,SPO2,PETCO2 and Ppeak were monitored and the venous blood samples were obtained to measure serum concentrations of epinephrine, NE, IL-6 and IL-10 by ELISA at different perioperation time: 5 min before anesthesia (T0), before the CO2 was insufflated into peritoneal cavity (T1)and 5 minutes after(T2),20 minutes after(T3), the end of peritoneal insufflation (T4)and 30 minutes after the end of peritoneal insufflation(T5). Blood samples from artery were obtained atT1,T2,T3,T4,T5 for blood gas analysis. The time of anesthesia , operation , wake-up and total amount of Propofol and Fentanyl used were recorded. All the data were analysed using PSS11.0 software.Results: There is no significant statistical difference in age, sex, weight, operation time, anesthesia time and aeroperitoneum time in two groups. The general data were comparable between two groups.⑴HR,MAP: MAP and HR were increased after peritoneal insufflation was created compared to T0 in group A(P<0.01 ), while the time-course was insignificant in Group B; No significant difference was found at T0 between two groups, but it was higher at T1,T2,T3,T4and T5 in Group A(P<0.01).⑵Epinephrine and NE :The serum concentration of Epinephrine and NE were increased gradually at T1,T2,T3,T4 in both groups compared to T0, and it was significantly higher at T5 than that at T0(P<0.01) , while the concentraion at T5 has decreased to pre-operation level in group B. There is no difference at T0 and T1 between two groups(P>0.05) . It was higher ) at T2,T3,T4,T5 in group A compared to group B (P<0.01).⑶interleukin :I L-6 was increased at T2,T3,T4,T5 in both groups compared to T0(P<0.01) , but it was decreased dramatically at T5. No statistical differences were found between groups. (4)The wake-up time of B group is shorter than that of A group(P<0.01) . The total amount of Propofol and Fentanyl of B group is less than that of A group(P<0.01).Conclusion:Serious stress response may be induced under pediatric Laparoscopic surgery. It can be effectively reduced if combined with epidural anesthesia, but showed little effects on serum IL-6,IL-10 levels.
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