Impact of Epidural Analgesia on Hemodynamics and Stress Markers in Children during Orthopedic Surgery

Abstract

Objective: to study the specific features of systemic hemodynamics and stress markers in young (1—5-year-old) and old (6—12-year-old) children during orthopedic surgery under intra- and postoperative epidural analgesia. Subjects and methods. Seventy-six children aged 1 to 12 years, who had undergone orthopedic surgery, were examined. According to their age and the type of intraoperative analgesia, the patients were divided into 4 groups. Groups 1 and 2 included children aged 1—5 years and Groups 3 and 4 did those aged 6-12 years. Total intravenous anesthesia with diprivan and fentanyl was used in Groups 1 and 3. Combination epidural anesthesia was performed in Groups 2 and 4. Central hemodynamic parameters and biochemical stress markers (adrenaline, cortisol, glucose, and interleukin-6) were estimated in the intra- and postoperative periods. Results. Slight reductions in peripheral vascular resistance and blood pressure without a considerable change in cardiac output were found to be typical hemodynamic responses in 1—5-year-old children during epidural anesthesia. In 6—12-year-old children under epidural anesthesia, the hemodynamic responses showed a similar trend, but they were more marked than those in young children. Adequate infusion therapy can prevent the reduced minute volume of circulation during epidural block. In the young and old children, epidural anesthesia exerts a more marked stress-protective effect than does total intravenous anesthesia, which manifests itself as a less significant rise in the level of stress markers intra- and postoperatively. Key words: epidural anesthesia, children, hemodynamics, surgical stress.