Stress-response during the Nuss procedure under the combination of general anesthesia with different regional blocks

Abstract

The perioperative stress-response is a dynamic process under the influence of patient-specific, surgical and anaesthesiologic factors.

Purpose – to evaluate stress response during the correction of pectus excavatum by Nuss under the combination of general anesthesia with different variants of the regional block.

Materials and methods. The observative prospective study included 60 adolescents (boys/girls=47/13) undergone Nuss procedure under the combination of general anesthesia and regional blocks. The patients were randomized into three groups (n=20 in each) according to the perioperative regional analgesia technique: standard epidural anesthesia (SEA) in Th5–Th8, high epidural anesthesia (HEA) in Th2–Th3, and bilateral paravertebral anesthesia (PVA) in Th5–Th8. The serum cortisol and glycemia were analyzed at three stages: 1 – baseline before surgery, 2 – during bar rotation, and 3 – after surgery finished.

Results. The average serum cortisol level among all patients before surgery was 342.4 [282.1–415.0] nmol/L. At stage 2 the plasma cortisol decreased up to 223.1 [174.9–282.3] nmol/L (p<0.000001). After the surgery and anesthesia finished the average plasma cortisol was 279.6 [216.7–312.6] nmol/L (p<0.000001 vs baseline). During surgery serum cortisol decreased in group SEA by 41%, in group HEA – by 30%, and in group PVA – by 31% compared with baseline levels. After surgery, the serum cortisol was lower than baseline measurements in group SEA by 28%, in group HEA – by 20%, and in group PVA – by 26%. The average baseline glycemia among all patients before surgery was 4.62 [4.01–5.05] mmol/L. At stage 2 glycemia decreased significantly up to 4.05 [3.86–4.62] mmol/L (p=0.00018). After the surgery finished the average serum glucose among all patients was 4.24 [4.09–4.99] mmol/L (p=0.7). At stage 2 serum glucose decreased in group SEA by 11%, in groups HEA and PVA – by 5% compared with the baseline level. The dynamics of serum cortisol and glycemia were similar in all groups with statistically insignificant intergroup differences at all three stages.

Conclusions. Serum cortisol and glycemia during the Nuss procedure under the combination of general anesthesia with regional blocks decreased significantly. After surgery finished glycemia returned to baseline level, but serum cortisol was lower than baseline measurement. The changes in serum cortisol and glycemia were more pronounced in patients under standard epidural analgesia in Th5–Th8 compared with the high epidural in Th2–Th3 and paravertebral blocks.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study.

The author declares no conflict of interest.