Dynamics of stress-response markers and the functional state of the autonomic nervous system as an indicator of sufficient anesthetic support using intravenous infusion of lidocaine in children
DOI:
https://doi.org/10.15574/PS.2022.77.9Keywords:
Kerdo index, index of functional changes, autonomic nervous system, blood glucose, cortisol, multimodal anesthesia, lidocaine infusion, childrenAbstract
Surgical stress causes a wide range of functional changes in different body systems in children: nervous, cardiovascular, respiratory, and endocrine. Antinociceptive protection is the main component of anesthetic support for pediatric patients due to the immaturity of neurohumoral regulation of the central and peripheral nervous systems in childhood and, therefore, the low adaptability of the child’s organism.
Purpose - to investigate stress-response markers and indicators of the functional state of the autonomic nervous system to assess the antinociceptive properties of intraoperative continuous intravenous infusion of lidocaine during surgical procedures in children.
Materials and methods controlled study included 74 children (boys/girls=50/24) who underwent surgical procedures under general anesthesia. Based on the method of general anesthesia, patients were divided into two groups: the standard general anesthesia with propofol and fentanyl, (the control group - n=46) and the general anesthesia with intraoperative intravenous infusion of lidocaine (the study (lidocaine) group - n=28). The adequacy of antinociceptive protection with different methods of anesthesia during surgical, urological, and traumatological procedures in children was compared by evaluation of stress marker levels and the functional state of the autonomic nervous system. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0 for Windows.
Results. The study found that the intraoperative activation of the sympathetic tone of the autonomic nervous system along with changes in blood glucose and cortisol are less pronounced in children who received a constant infusion of lidocaine. Indicators of the functional state of the autonomic nervous system correlate with postoperative levels of stress markers.
Conclusions. Prolonged perioperative infusion of lidocaine at a dose of 0.5-2 mg/kg/hour as a component of multimodal anesthesia during surgical procedures in children provides more pronounced antinociceptive protection than anesthesia with propofol in combination with fentanyl.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Batko I, Koscielniak-Merak B, Tomasik PJ, Kobylarz K, Wordliczek J. (2020). Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study. Pharmacol Rep. 72 (3): 744-755. https://doi.org/10.1007/s43440-020-00100-7; PMid:32297162 PMCid:PMC7329801
De Oliveira CM, Issy AM, Sakata RK. (2010). Intraoperative intravenous lidocaine. Rev Bras Anestesiol. 60 (3): 325-333. https://doi.org/10.1016/S0034-7094(10)70041-6; PMid:20682165
Gilbert CR, Hanson IR, Brown AB, Hingson RA. (1951). Intravenous use of xylocaine. Curr Res Anesth Analg. 30 (6): 301-313. https://doi.org/10.1213/00000539-195101000-00057
Hall EA, Sauer HE, Davis MS, Anghelescu DL. (2021). Lidocaine Infusions for Pain Management in Pediatrics. Paediatr Drugs. 23 (4): 349-359. https://doi.org/10.1007/s40272-021-00454-2; PMid:34036532 PMCid:PMC8609473
Ilies C, Gruenewald M, Ludwigs J et al. (2010). Evaluation of the surgical stress index during spinal and general anaesthesia. Br J Anaesth. 105 (4): 533-537. https://doi.org/10.1093/bja/aeq203; PMid:20682572
Kahveci K, Ornek D, Doger C et al. (2014). The effect of anesthesia type on stress hormone response: comparison of general versus epidural anesthesia. Niger J Clin Pract. 17 (4): 523-527. https://doi.org/10.4103/1119-3077.134058; PMid:24909481
Koscielniak-Merak B, Batko I, Kobylarz K, Sztefko K, Tomasik PJ. (2020). Intravenous, perioperatively administered lidocaine regulates serum pain modulators' concentrations in children undergoing spinal surgery. Pain Med. 21 (7): 1464-1473. https://doi.org/10.1093/pm/pnz212; PMid:31504866
MacFater WS, Rahiri JL, Lauti M, Su'a B, Hill AG. (2017). Intravenous lignocaine in colorectal surgery: a systematic review. ANZ J Surg. 87 (11): 879-885. Epub 2017 Jul 5. https://doi.org/10.1111/ans.14084; PMid:28677829
McHoney M, Eaton S, Pierro A. (2009). Metabolic response to surgery in infants and children. Eur J Pediatr Surg. 19 (5): 275-285. https://doi.org/10.1055/s-0029-1241192; PMid:19830630
Myhal II. (2021). Stress-response during the Nuss procedure under the combination of general anesthesia with different regional blocks. Paediatric Surgery. Ukraine. 2 (71): 14-20. https://doi.org/10.15574/PS.2021.71.14
Mynvaleeva RS. (2009). Vehetatyvniy Yndeks Kerdo: yndeks dlia otsenky vehetatyvnoho tonusa, vichysliaemiy yz dannikh krovoobrashchenyia. Sportyvna medytsyna. 1-2: 33-44.
Nakhli MS, Kahloul M, Guizani T, Zedini C, Chaouch A, Naija W. (2018). Intravenous lidocaine as adjuvant to general anesthesia in renal surgery Libyan J Med. 13 (1): 1433418. https://doi.org/10.1080/19932820.2018.1433418; PMid:29433385 PMCid:PMC5814763
Palmieri TL, Lerine S, Schonffeld-Warden N, O'Mara MS, Greenhalgh DG. (2006). Hypothalamic-pituitary-adrenal axis response to sustained stress after major burn injury in children. J Burn Care Res. 27 (5). 742-748. https://doi.org/10.1097/01.BCR.0000238098.43888.07; PMid:16998409
Pushkar MB, Heorhiiants MA. (2015). Markery stresu ta stan rehuliatornykh system pry adenotomii u ditei. Medytsyna neotlozhnykh sostoianyi. 5: 144-147. https://doi.org/10.22141/2224-0586.5.68.2015.78561
Reis FМ, Ribeiro-de-Oliveira A, Machado LJ, Guerra RM, Reis AM, Coimbra CC. (1998). Plasma prolactin and glucose alterations induced by surgical stress: a single or dual response? Exp Physiol. 83 (1): 1-10. https://doi.org/10.1113/expphysiol.1998.sp004086; PMid:9483415
Rove KO, Edney JC, Brockel MA. (2018). Enhanced recovery after surgery in children: Promising, evidence-based multidisciplinary care. Paediatr Anaesth. 28 (6): 482-492. https://doi.org/10.1111/pan.13380; PMid:29752858
Sloan T, Mongan P, Lyda C, Koht A. (2014). Lidocaine infusion adjunct to total intravenous anesthesia reduces the total dose of propofol during intraoperative neurophysiological monitoring. J Clin Monit Comput. 28 (2): 139-147. https://doi.org/10.1007/s10877-013-9506-x; PMid:23996498
Soto G, Naranjo Gonzalez M, Calero F. (2018). Intravenous lidocaine infusion. Revista Espanola de Anestesiologia y Reanimacion. 65 (5): 269-274. https://doi.org/10.1016/j.redar.2018.01.004; PMid:29496229
Weibel S, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Kranke P. (2016). Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. Br J Anaesth. 116 (6): 770-783. https://doi.org/10.1093/bja/aew101; PMid:27199310
Wren K, Lancaster RJ. Walesh M, Margelosky K, Leavitt K, Albala MZ. (2019). Intravenous Lidocaine for Relief of Chronic Neuropathic Pain. AANA Journal. 87 (5): 351-355.
Yuki K, Matsunami E, Tazawa K, Wang W, DiNardo JA, Koutsogiannaki S. (2017). Pediatric Perioperative Stress Responses and Anesthesia. Transl Perioper Pain Med. 2 (1): 1-12.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
