Prospective assessment of surgical stress response in patients with craniosynostosis: comparison of clinical and laboratory data

Bashiryan BA, Gadzhieva OA, Satanin LA, et al. Prospective assessment of surgical stress response in patients with craniosynostosis: comparison of clinical and laboratory data. Burdenko's Journal of Neurosurgery. 2024;88(4):62‑70. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20248804162

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

Close metadata

BACKGROUND

Highly traumatic surgical correction of craniosynostosis (CS) is usually followed by severe postoperative period and high risk of complications. Surgical stress response (SSR) is an important and often neglected cause of severe early postoperative period.

OBJECTIVE

To compare clinical and laboratory parameters of SSR in children who underwent various surgeries for CS.

MATERIAL AND METHODS

The study included 63 patients aged 7.02±4.12 months. All ones underwent surgery for CS between October 2021 and June 2022. We analyzed clinical and laboratory markers of SSR, as well as correlation with severity of surgical stress.

RESULTS

No surgical complications were observed. There were postoperative complications in 12 (19.0%) cases including febrile fever in 9 (14.3%) patients, severe pain and edematous syndromes with prolonged hospital-stay in 3 (4.8%) cases. Significant correlations were revealed between severity of surgical stress and certain laboratory markers (CRP, ACTH, T3, insulin, HOMA-IR). The last ones characterized SSR severity. Patients with high scores of stress response demonstrated more severe course of early postoperative period.

CONCLUSION

Surgical stress scale makes it possible to predict early postoperative period and optimize patient management. Lower severity of surgical stress response following endoscopic interventions is another reason for the wider use of low-traumatic surgical methods in pediatric neurosurgery.

Keywords:

craniosynostosis

reconstructive surgery

surgical stress response

inflammatory markers

C-reactive protein

hormonal status

metabolic disorders

stress response modulation

Authors:

Bashiryan B.A.

Burdenko National Medical Research Center of Neurosurgery

ORCID: 0000-0002-5559-2678

Gadzhieva O.A.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9850-050X

Satanin L.A.

Burdenko Neurosurgical Center

ORCID: 0000-0003-2051-1855

Mazerkina N.A.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0428-0498

Khukhlaeva E.A.

Burdenko Neurosurgical Center

ORCID: 0000-0002-7961-4245

Lavrenyuk E.A.

Burdenko Neurosurgical Center

ORCID: 0009-0004-8477-9564

Tere V.A.

Burdenko Neurosurgical Center

ORCID: 0000-0003-4247-8953

Kvan O.K.

Burdenko Neurosurgical Center

ORCID: 0000-0002-6147-7887

Roginsky V.V.

Burdenko Neurosurgical Center

SPIN RSCI: 2873-4899
ORCID: 0000-0003-0549-855X

Received:

21.02.2024

Accepted:

31.05.2024

Close metadata

References:

Roginsky VV, Khachatryan VA, Satanin LA, Kim AV, Ivanov VP, Samochernykh KA, Solonichenko VG, Glagolev NV, Zemlyanikin VV, Ivanov AL, Kabanyan AB, Letyagin GV, Pak OI, Semenova ZhB, Timershin AG, Shamkhalov HSh, Sakharov AV, Iova AS. Topical issues of diagnosis and surgical treatment of children with craniosynostoses. Neurosurgery and Neurology of childhood. 2019;59(1):56-74. (In Russ.).
Kearney R, Rosales J, Howes W. Craniosynostosis: an assessment of blood loss and transfusion practices. Canadian Journal of Anaesthesia. 1989;36(4):473-477. https://doi.org/10.1007/BF03005352
Esparza J, Hinojosa J. Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures. Child’s Nervous System. 2008;24(12):1421-1430. https://doi.org/10.1007/s00381-008-0691-8
Esparza J, Hinojosa J, García-Recuero I, Romance A, Pascual B, Martínez de Aragón A. Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases. Neurocirugia. 2008;19(6):509-529. https://doi.org/10.1016/s1130-1473(08)70201-x
Lee H, Hutson J, Wray A, Lo P, Chong D, Holmes A, Greensmith A. Analysis of Morbidity and Mortality in Surgical Management of Craniosynostosis. Journal of Craniofacial Surgery. 2012;23(5):1256-1261.
Ovechkin AM. Surgical stress response, its pathophysiological significance and modulation methods. Regional anesthesia and treatment of acute pain. 2008;2(2):49-62. (In Russ.).
Desborough J. The stress response to trauma and surgery. British journal of anaesthesia. 2000;85(1):109-117. https://doi.org/10.1093/bja/85.1.109
Salhotra R, Kamal V, Tyagi A, Mehndiratta M, Rautela R, Almeida E. Suppression of perioperative stress response in elective abdominal surgery: A randomized comparison between dexmedetomidine and epidural block. Journal of anaesthesiology, clinical pharmacology. 2023;39(3):397-403. https://doi.org/10.4103/joacp.joacp_559_21
Bozkurt P, Kaya G, Altintas F, Yeker Y, Hacibekiroglu M, Emir H, Sarimurat N, Tekant G, Erdogan E. Systemic stress response during operations for acute abdominal pain performed via laparoscopy or laparotomy in children. Anaesthesia. 2000;55(1):5-9. https://doi.org/10.1046/j.1365-2044.2000.01119.x
Bouwmeester N, Anand K, Dijk M, Hop W, Boomsma F, Tibboel D. Hormonal and metabolic stress responses after major surgery in children aged 0-3 years: a double-blind, randomized trial comparing the effects of continuous versus intermittent morphine. British journal of anaesthesia. 2001;87(3):390-399. https://doi.org/10.1093/bja/87.3.390
Gajarski R, Stefanelli C, Graziano J, Kaciroti N, Charpie J, Vazquez D. Adrenocortical response in infants undergoing cardiac surgery with cardiopulmonary bypass and circulatory arrest. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2010;11(1):44-51. https://doi.org/10.1097/PCC.0b013e3181a64743
Naguib A, Tobias J, Hall M, Cismowski M, Miao Y, Barry N, Preston T, Galantowicz M, Hoffman T. The role of different anesthetic techniques in altering the stress response during cardiac surgery in children: a prospective, double-blinded, and randomized study. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2013;14(5):481-490. https://doi.org/10.1097/PCC.0b013e31828a742c
Gruber E, Laussen P, Casta A, Zimmerman A, Zurakowski D, Reid R, Odegard K, Chakravorti S, Davis P, McGowan F, Hickey P, Hansen D. Stress response in infants undergoing cardiac surgery: a randomized study of fentanyl bolus, fentanyl infusion, and fentanyl-midazolam infusion. Anesthesia and analgesia. 2001;92(4):882-890. https://doi.org/10.1097/00000539-200104000-00016
McHoney M, Eaton S, Pierro A. Metabolic response to surgery in infants and children. European journal of pediatric surgery. 2009;19(5):275-285. https://doi.org/10.1055/s-0029-1241192
Yuki K, Matsunami E, Tazawa K, Wang W, DiNardo J, Koutsogiannaki S. Pediatric Perioperative Stress Responses and Anesthesia. Translational perioperative and pain medicine. 2017;2(1):1-12.
Powis M, Smith K, Rennie M, Halliday D, Pierro A. Effect of major abdominal operations on energy and protein metabolism in infants and children. Journal of pediatric surgery. 1998;33(1):49-53. https://doi.org/10.1016/s0022-3468(98)90360-8
Bashiryan BA, Gadzhieva OA, Satanin LA, Lavrenyuk EA, Tere VA, Mazerkina NA, Sakharov AV, Getmanova IV, Roginsky VV. Prospective analysis of inflammatory markers and perioperative clinical data in children with craniosynostosis undergoing reconstructive surgery. Burdenko’s Journal of Neurosurgery. 2024;88(1):70-78. (In Russ.). https://doi.org/10.17116/neiro20248801170
Bashiryan BA, Satanin LA, Gadzhieva OA, Mazerkina NA, Lavrenyuk EA, Tere VA, Kvan OK, Sakharov AV, Getmanova IV, Roginsky VV. Dynamics of hormonal and biochemical markers of stress response during reconstructive surgery in children with craniosynostoses. The Russian Neurosurgical Journal named after prof. A.L. Polenov. 2024(2):47-52. (In Russ.).
Anand K, Brown M, Causon R, Christofides N, Bloom S, Aynsley-Green A. Can the human neonate mount an endocrine and metabolic response to surgery? Journal of pediatric surgery. 1985;20(1):41-48. https://doi.org/10.1016/s0022-3468(85)80390-0
Gvack GV, Eremenko VG. Stress-limiting systems of optimization and improvement of quality of general anaesthesia in children. Siberian medical journal. 2012;113(6):90-93. (In Russ.).
Samokhvalov IM, Zachiniaev GV, Andrukov BG, Golovko KP, Apchel VYa. Endocrine stress response dynamics in the surgery for calculous cholecystitis. Bulletin of the Russian Military Medical Academy. 2013;3(43):38-42. (In Russ.).
Nakamura M, Suita S, Yamanouchi T, Masumoto K, Ogita K, Taguchi S, Uesugi T. Cortisol and cytokine responses after surgery in different age groups of pediatric patients. Pediatric surgery international. 2003;19(3):194-199. https://doi.org/10.1007/s00383-002-0917-x
Black S, Kushner I, Samols D. C-reactive Protein. The Journal of biological chemistry. 2004;279(47):48487-48490. https://doi.org/10.1074/jbc.R400025200
Finnerty C, Mabvuure N, Ali A, Kozar R, Herndon D. The surgically induced stress response. JPEN Journal of parenteral and enteral nutrition. 2013;37(5 suppl):21S-29S. https://doi.org/10.1177/0148607113496117