Comparative study of the analgesic and anti-stress effect of inhalation anesthesia in children with cancer and trauma pathology during surgical treatment

Abstract

Background. Adequate anesthesia is of great importance for patient safety, it reduces stress reactions to surgery and trauma. The perfection of modern anesthesia allows performing complex operations in different age periods in patients at high surgical and anesthetic risk. To limit the activation of neuroendocrine, inflammatory and immune reactions during surgery, new methods of anesthesia are constantly being searched for, different inhalation and non-inhalation drugs for anesthesia are compared in order to find an ideal “stress-free” anesthetic. Currently, during cancer surgeries, sevoflurane is widely used, but there are few studies showing efficiency of this inhalation anesthetic in children during surgical treatment of tumors and its effect on operative trauma and the reaction of the child’s body to stress. The purpose of our research is to study the extent to which sevoflurane limits the activation of neurovegetative, inflammatory, and immune responses in children during cancer surgery. Materials and methods. Twenty-seven children (first group) aged from 1 to 17 years (6.04 ± 5.84 years), who came for surgical treatment of cancer, were examined. To compare the studied indicators, 23 children (second group) aged from 2 to 17 years (10.68 ± 4.21 years) were additionally examined, they were scheduled for surgical treatment of trauma pathology. Results. Evaluation of the adequacy of sevoflurane anesthesia during operations in cancer and trauma patients showed that most hemodynamic parameters had similar changes at all stages, which is typical for this type of anesthesia. We studied changes in C-reactive protein and circulating cytokines before and after anesthesia with sevoflurane in children with cancer and trauma pathology. C-reactive protein level increased 4 times, but initially its level was 2–2.5 times higher in cancer patients. Similar dynamics was demonstrated with pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor). By the end of surgical intervention, a significant increase of cortisol was noted; however, in the children of the second group, the level of this hormone increased more compared with cancer patients. All spectral indicators of heart rate variability, which testified to the tension of the autonomic nervous system, had a significant difference between the groups. Conclusions. During inhalation anesthesia with sevoflurane, the profile of stress response in children with cancer differs from that in patients with trauma pathology.