Biochemical markers of surgical stress in endoscopic rhinosinus surgery under combined anesthesia in children

BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children.

MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 6–17 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygen–air mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an air–oxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.7–0.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an air–oxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia.

RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group.

DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values.

CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.