ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2016, 1(2): 117–120

Efficiency of Central Neuroaxial Anesthesia in Surgical Newborns

Kurochkin M.Yu., Davydova A.H., Horodkova Yu.V.

Regional anesthesia is increasingly used in pediatric practice as a component of multicomponent intraoperative anesthesia and postoperative analgesia. Central neuroaxial anesthetic technics are especially valuable in newborns because opioid receptors in this age are still very immature and it requires the appointment of large doses of narcotic analgesics. Caudal-epidural administration of local anesthetics in infants allows to block the majority of pain impulses through the spinal cord due to their wide distribution in the epidural space, so their use should be more effective than traditional methods of general anesthesia. The aim of the work was to evaluate the effectiveness of the spinal and caudal - epidural anesthesia in surgical newborns by studying the dynamics of blood markers of stress and of cellular protection to identify the advantages over traditional general anesthesia. The study were conducted in 40 infants with such surgical pathology as congenital gastro-intestinal tract malformations (esophageal atresia, diaphragmatic hernia, high or low intestinal obstruction, anterior abdominal wall defect). Depending on the method of combined general anesthesia (in all children the mechanical lung ventilation was carried out) patients were divided into 2 groups. The main group (1st) included 15 newborn children for whom spinal and caudal-epidural anesthesia by bupivacaine solution (Marcaine) was applied. We inserted 2 mg/kg of bupivacaine and 0,9% saline to the whole volume 1-1,2 ml/kg caudally into epidural space and 0,4 mg/kg of bupivacaine into the spinal canal. Control group included 25 newborns for whom traditional multicomponent anesthesia with high dosed of Fentanyl (50-75 mcg/kg/hour was applied. The level of cortisol, markers of cellular protection (in hemolisate) were defined ELISA method, glucose level – by a portable blood glucose meter. Blood samples were taken from a central venous catheter in 4 stages: before surgery, during the surgical operation, after one day and three days after surgery. Equalizing the level of stress markers (nitrites, cortisol, glucose) in the control group in comparison with the main group we noted the high degree of reliability in cortisol and glucose levels raising (p <0.001) during surgical interference; in the mail group there were no increasing of these indexes, and nitrites and cortisol even decreased in comparison with the baseline levels. In the early postoperative period the comparison between the control group and the study group was the same - cortisol and glucose was significantly higher in the control group (p <0.001). In children of the first group of hemolisate indicators of cellular protection (glutathione transferase, glutathione reductase, the level of overall thiols, glutathione peroxidase) didn’t significantly changed during surgical interference. Children 2 groupsthese indicators increased significantly during surgery - by 18-40% compared with baseline values. In the postoperative period, in the main group of children there were no significant changes in Glutathione transferase, glutathione reductase, glutathione and total thiols levels. In the 2d group of children at this stage only glutathione level increased, other indicators did not change significantly, and their normalization was observed on the third day after surgery. Thus it is proved that the benefits of combined spinal - epidural caudal anesthesia in comparison with conventional multicomponent anesthesia is the rapidness of development (3-4 minutes) and more reliable antinociceptive effect. This is confirmed by a significant decrease in blood markers of stress - glucose and cortisol - during operations. At the same time cellular protection markers (catalase, glutathione peroxidase, glutathione and total thiols) did not change significantly in all phases of the study. In the control group, where a multicomponent general anesthesia with high doses of fentanyl was used, there was a significant increase in cortisol, glucose, nitrite, and markers of cellular protection during operations.

Keywords: newborns, neuroaxial blockade, stress markers, efficacy

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