Elsevier

The Lancet

Volume 329, Issue 8527, 31 January 1987, Pages 243-248
The Lancet

RANDOMISED TRIAL OF FENTANYL ANAESTHESIA IN PRETERM BABIES UNDERGOING SURGERY: EFFECTS ON THE STRESS RESPONSE

https://doi.org/10.1016/S0140-6736(87)90065-1Get rights and content

Abstract

In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 μg/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the non-fentanyl than in the fentanyl group. The urinary 3-methylhistidine/creatinine ratios were significantly greater in the non-fentanyl group on the second and third postoperative days. Compared with the fentanyl group, the non-fentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.

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    1

    Present address: Department of Anesthesia, Harvard Medical School, Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA.

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