Endocrine and metabolic monitoring for anesthesia care in orthopedic trauma surgery on the lower extremities of children: prospective comparative study

BACKGROUND: Standard anesthesia monitoring during surgery only indirectly allows us to estimate achieving an effective level of analgesia sufficient to protect the patient from surgical trauma. Recently, studies have analyzed cortisol, glucose, and lactate levels during surgery in children and adults; however, data presented remain inconsistent.

OBJECTIVE: This study aimed to conduct a prospective comparative analysis of endocrine metabolic dynamic rates in orthopedic trauma surgery on the lower extremities of children.

MATERIALS AND METHODS: The study included 39 children who underwent orthopedic trauma surgery. They were divided into two groups: group 1 (n=17) underwent multicomponent balanced general anesthesia, and group 2 (n=22) received combined anesthesia (multicomponent balanced general anesthesia combined with regional blockade of the sciatic and femoral nerves). The dynamics of cortisol, glucose, and lactate indicators at three stages of the perioperative period, total amount of fentanyl, and need for an inhalation anesthetic were examined.

RESULTS: Indicators of cortisol, glucose, and lactate in mixed venous blood during surgery did not exceed the age norm in both groups. In group 1, cortisol, glucose, and lactate levels did not statistically differ at all stages of the study. In group 2, cortisol and lactate levels increased at the fifth stage (traumatic stage) of surgery, and lactate levels increased in the sixth stage (end of surgery). In intergroup comparison, the lactate level at the traumatic stage of surgery was higher in group 1 than in group 2 (p=0.048). Cortisol and glucose levels at the stages of the study did not differ significantly. The total amount of fentanyl for pain relief in group 1 was 4.1 [3.3; 5.0] µg/kg, which was 8.2 times higher than that in group 2, with 0.5 [0.4; 0.53] µg/kg (p <0.0001).

CONCLUSION: Both anesthesia methods ensure stable levels of cortisol, glucose, and lactate, and adequate level of analgesia at all stages of surgery; however, the use of a conduction blockade as a component of combined anesthesia provides more pronounced antinociceptive protection and reduces surgical stress in children.