Randomised Trial of Fentanyl Anaesthesia in Preterm Babies Undergoing Surgery: Effects on the Stress Response

Lancet. 1987 Jan 31;1(8527):243-8. doi: 10.1016/s0140-6736(87)90065-1.

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 micrograms/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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Corrected and Republished Article
  • Randomized Controlled Trial

MeSH terms

  • Anesthesia, General / methods*
  • Blood Glucose / analysis
  • Clinical Trials as Topic
  • Curare / administration & dosage
  • Ductus Arteriosus, Patent / surgery
  • Fentanyl / administration & dosage
  • Fentanyl / pharmacology*
  • Hormones / blood
  • Humans
  • Hyperglycemia / prevention & control
  • Infant, Newborn
  • Infant, Premature, Diseases / surgery*
  • Lactates / blood
  • Nitrous Oxide / administration & dosage
  • Postoperative Complications / prevention & control
  • Pyruvates / blood
  • Random Allocation
  • Stress, Physiological*

Substances

  • Blood Glucose
  • Hormones
  • Lactates
  • Pyruvates
  • Curare
  • Nitrous Oxide
  • Fentanyl