• Paediatric anaesthesia · Oct 2018

    Observational Study

    Autonomic cardiac regulation after general anesthesia in children.

    • Théa Venet, Vincent Pichot, David Charier, Aurélien Scalabre, and Hugues Patural.
    • Pediatric Intensive Care Unit, University Hospital of Saint-Étienne, Saint-Étienne, France.
    • Paediatr Anaesth. 2018 Oct 1; 28 (10): 881-887.

    BackgroundGeneral anesthesia dramatically decreases the activity of the autonomic nervous system. Most of the hypnotic agents used to induce anesthesia inhibit sympathetic cardiovascular regulation and baroreflex control in a dose-dependent manner, lowering cardiac adaptability during the operation. The consequence of this effect in children during and after surgery has never been studied to date.AimThe aim of this study was to follow the variations in autonomic cardiac indices in children younger than 8 years old after general anesthesia (6-24 hours) in programmed surgery.MethodA prospective descriptive monocentric study of 44 children under 8 years old who underwent scheduled surgery at our hospital center (Saint-Étienne University Hospital, France) was performed between June 1, 2016 and November 1, 2016. Heart rate variability was monitored for 24 hours using Holter-ECG devices and the resulting data were interpreted using linear and nonlinear analyses.ResultsCompared to baseline thresholds before surgery, all heart rate variability indices decreased dramatically during general anesthesia. After awakening, a slight reduction in sympathetic activity persisted 6 hours after surgery, but all measurements of sympathetic and parasympathetic activity had returned to baseline thresholds 12 hours after the operation. Twenty-four hours after surgery, some parameters had increased above the corresponding baseline levels.ConclusionAutonomic nervous function normalizes rapidly (within 12 hours) in prepubertal children. This study indicates that general anesthesia does not seem to increase the long-term risk of autonomic dysfunction in these patients.© 2018 John Wiley & Sons Ltd.

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