Myocardial Protection By Caudal Block In Pediatric Patients Undergoing Surgery For Developmental Dysplasia Of The Hip

OBJECTIVE: To detect the serum levels of inflammatorycytokines TNF-α and IL-6and cardiac markers CK-MB, cTnI andNT-pro BNP to identify the existence of post-operative myocardial injuryand cardiac dysfunction in children undergoing surgery fordevelopmental dysplasia of the hip. To establish whether thepost-operative myocardial injury and cardiac dysfunction are associatedwith inflammatory cytokines TNF-α and IL-6. To investigate whethercaudal block combined with general anesthesia could reducepost-operative myocardial injury and cardiac dysfunction throughinhibiting the production of inflammatory cytokines TNF-a and IL-6inchildren undergoing surgery for developmental dysplasia of the hip.METHODS: Forty-two patients, ASA I,18months to5years old,were randomly allocated into two groups: group C received caudal salinecombined with general anesthesia and group R received caudalropivacaine0.2mg/kg combined with general anesthesia. Induction andmaintenance of anesthesia followed a standardized protocol. There weretwo patients of group R lost follow-up. Finally,21patients of group Cand19patients of group R with the experimental data were statisticallyanalyzed. The following measurements were made perioperatively: serumCK-MB, cTnI, NT-pro BNP, TNF-α and IL-6levels. Other parametersrecorded were duration of operation, pre-operative and post-operative hemoglobin levels, intraoprative remifentanil consumption andpost-operative fentanyl consumption.RESULTS: There were no differences in the patient characteristicdata between two groups. Serum TNF-α levels began to decrease（P<0.05） after operation and increased at72h after operation. SerumIL-6levels significantly elevated after operation（P<0.05）, peaked at24hafter operation and began to fall at48h after operation. Serum CK-MBand cTnI levels elevated after operation in both groups（P<0.05）andpeaked at3h after operation. Serum NT-pro BNP levels increased afteroperation and peaked at24h after operation. Serum IL-6, CK-MB, cTnIand NT-pro BNP levels were significantly higher in control group afteroperation（P<0.05）. There was a significant positive correlation betweenIL-6and NT-pro BNP levels (R=0.571, P=0.000).CONCLUSION: Compared with general anesthesia, caudal blockcombined with general anesthesia could inhibit the production ofinflammatory cytokine IL-6and reduce the increase of post-operativeserum cardiac markers CK-MB, cTnI and NT-pro BNP levels in childrenundergoing surgery for developmental dysplasia of the hip receivedgeneral anesthesia. There was a significant positive correlation betweenIL-6and NT-pro BNP levels. OBJECTIVE: To detect the serum levels of inflammatorycytokines TNF-α and IL-6and cardiac markers CK-MB, cTnI andNT-pro BNP to identify the existence of post-operative myocardial injuryand cardiac dysfunction in children undergoing surgery fordevelopmental dysplasia of the hip. To establish whether thepost-operative myocardial injury and cardiac dysfunction are associatedwith inflammatory cytokines TNF-α and IL-6. To investigate whethercaudal block combined with general anesthesia could reducepost-operative myocardial injury and cardiac dysfunction throughinhibiting the production of inflammatory cytokines TNF-a and IL-6inchildren undergoing surgery for developmental dysplasia of the hip.METHODS: Forty-two patients, ASA I,18months to5years old,were randomly allocated into two groups: group C received caudal salinecombined with general anesthesia and group R received caudalropivacaine0.2mg/kg combined with general anesthesia. Induction andmaintenance of anesthesia followed a standardized protocol. There weretwo patients of group R lost follow-up. Finally,21patients of group Cand19patients of group R with the experimental data were statisticallyanalyzed. The following measurements were made perioperatively: serumCK-MB, cTnI, NT-pro BNP, TNF-α and IL-6levels. Other parameters recorded were duration of operation, pre-operative and post-operativehemoglobin levels, intraoprative remifentanil consumption andpost-operative fentanyl consumption.RESULTS：There were no differences in the patient characteristicdata between two groups. Serum TNF-α levels began to decrease（P<0.05） after operation and increased at72h after operation. SerumIL-6levels significantly elevated after operation（P<0.05）, peaked at24hafter operation and began to fall at48h after operation. Serum CK-MBand cTnI levels elevated after operation in both groups（P<0.05）andpeaked at3h after operation. Serum NT-pro BNP levels increased afteroperation and peaked at24h after operation. Serum IL-6, CK-MB, cTnIand NT-pro BNP levels were significantly higher in control group afteroperation（P<0.05）. There was a significant positive correlation betweenIL-6and NT-pro BNP levels (R=0.571, P=0.000).CONCLUSION: Compared with general anesthesia, caudal blockcombined with general anesthesia could inhibit the production ofinflammatory cytokine IL-6and reduce the increase of post-operativeserum cardiac markers CK-MB, cTnI and NT-pro BNP levels in childrenundergoing surgery for developmental dysplasia of the hip receivedgeneral anesthesia. There was a significant positive correlation betweenIL-6and NT-pro BNP levels.