Anesthesia-dependent stress responses in pediatric anorectal abnormalities

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.