Efficacité protectrice de trois méthodes anesthésiques àl'égard du stress chirurgical chez l'enfant

Hormonal-metabolic stress responses have bevond doubt an effect on morbidity/mortality related to surgery. The present study aimed to determine which anaesthetic technique could afford the best protection in children, through analysis of the perioperative Cortisol, prolactin and beta-endorphin plasma levels. Thirty-six young patients 3-10 years old, ASA I-II, scheduled for hypospadias or vesicoureteral reflux surgery of a duration > 60 min, were randomized into three groups (n = 12). Children of group 1 were given initially propofol and fentanyl then isoflurane 1% ; group 2 received TIVA with propofol and fentanyl, group 3 received initially propofol then an epidural lumbar block with bupivacaine 0.25% (single shot) and continuous propofol i.v. infusion. Cortisol, prolactin and beta-endorphin levels increased significantly in group 1 only. No significant differences were observed between groups 2 and 3. Early postoperative analgesia was better in group 3. These data suggest that TIVA and particularly epidural block could afford a better protection against the surgical stress in children submitted to subumbilical operations.