Stress indicators during general anesthesia with opioid analgesics in children

Authors: BILJANA DRASKOVIC, DANICA STANIC, ANNA URAM-BENKA, IZABELA FABRI

Abstract: To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. Materials and methods: This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). Results: The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P = 0.939). Conclusion: Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.

Keywords: Children, stress response, opioid analgesics, surgical intervention

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