Stress indicators during general anesthesia with opioid analgesics in children

Background/aim: To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. Materials and methods: This was a prospective, observational clinical study. The study included 150 boys, aged 2–5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). Results: The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P = 0.939). Conclusion: Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.