Effect of anesthesia on hemodynamics in correction of anorectal abnormalities in children: a randomized study

Abstract

INTRODUCTION: Anorectal anomalies are one of the most common congenital malformations in children that require corrective surgical interventions. OBJECTIVE: To study the influence of anesthesia on the hemodynamic indices in the correction of anorectal anomalies in children. MATERIALS AND METHODS: A prospective single-center randomized study. Sixty children were examined, all underwent posterior sagittal anorectoplasty according to Penya. Children were divided into two groups: group 1 - combined anesthesia (n = 30), group 2 - general with regional anesthesia (n = 30). The study included five stages: Stage I - one day before surgery; Stage II - after induction of anesthesia; Stage III - bowel reduction; Stage IV - awakening; Stage V - one day after surgery. Heart rate (HR), systolic and diastolic blood pressure (BP), ejection fraction (EF) and stroke volume (SV) were assessed during the study. RESULTS: It was revealed that at the stage of bowel movement in children where concomitant anesthesia was used, there was a more pronounced decrease of HR (120 vs 106; p < 0.001). Similar changes were characteristic of diastolic BP (48 vs 42; p < 0.001). Mean BP was also significantly lower in the concomitant anesthesia group, and this was statistically significant in both stages III and IV (59.3 vs 54.7, p < 0.001; 61.5 vs 57.0, p < 0.001). In the group where combined anesthesia was used, a decrease in stroke volume was noted at the awakening stage, which was statistically significant compared to the I-III stages. The maximum ejection fraction indices were observed at the stage of bowel lowering against the background of combined anesthesia, which was statistically significant compared to other stages of the study CONCLUSIONS: At the stage of bowel reduction using concomitant anesthesia there was a significant statistically significant decrease of HR and systemic BP which was most probably due to the powerful sympatholytic effect of local anesthetics.