BACKGROUND

Any surgery in children is associated with stress reaction. Severity of this reaction depends on anesthesia quality and protection against surgical aggression.

OBJECTIVE

To study anesthesia-dependent stress responses in pediatric anorectal abnormalities.

MATERIAL AND METHODS

A prospective single-center randomized trial enrolled 60 children after posterior anorectoplasty by Peña. Children were divided into two groups: the 1st group — combined anesthesia (n=30); the 2nd group — concomitant anesthesia (n=30). The study included five stages: stage I — day before surgery; stage II — after induction of anesthesia; stage III — intestinal descent; stage IV — awakening; stage V — day after surgery. Serum glucose, cortisol and lactate, heart rate, systolic and diastolic blood pressure, ejection fraction and stroke volume were assessed at all stages.

RESULTS

There were no between-group differences in glycaemia at all stages of the study. At stage III, serum cortisol significantly decreased in the 2nd group (8.0 vs 10.3 nmol/l; p=0.035). Serum lactate was also lower in the 2nd group (1.0 vs 1.2 mmol/l; p=0.02). We found moderate negative correlations between serum cortisol and hemodynamic parameters at stages III and IV in the 2nd group. At stage V, there was a positive moderate correlation between serum cortisol and diastolic pressure (R=0.48; p=0.00).

CONCLUSION

Concomitant anesthesia in children with anorectal malformations has a more pronounced anti-stress effect and provides adequate protection in perioperative period.