MODIFYING INFANT STRESS RESPONSES TO MAJOR SURGERY - SPINAL VS EXTRADURAL VS OPIOID ANALGESIA

Twenty-six infants due to undergo major abdominal or thoracic surgery under general anaesthesia were randomized to receive additional analge sia with group A) spinal/epidural analgesia; B) epidural analgesia or C) opioid analgesia with fentanyl. We wished to determine if spinal an algesia followed by epidural analgesia might result in more complete c ontrol of cardiovascular or stress responses than the other two treatm ent groups. Heart rate and blood pressure were recorded at five min in tervals throughout surgery. Blood samples were taken for measurement o f catecholamines and whole blood sugar on induction, 45 min after skin incision and at the end of surgery. Heart rate rose significantly at the start of surgery in groups B and C but not group A. Systolic blood pressures were higher in group C compared to A and B. The rise in pla sma glucose concentrations was significantly different between the gro ups in the order C>B>A (P<0.05). A similar trend was seen in the plasm a adrenaline and noradrenaline concentrations but this failed to achie ve significance due to the limited sample size.