Abstract
In order to test the hypothesis that the metabolic response to surgery in childhood would vary both with age and severity, 46 children aged 1 month to 10 years undergoing a variety of operations under a standard anaesthetic were studied.
Blood samples were drawn pre- and post-operatively and 6, 12, 24 and 48 hours after surgery. Blood concentrations of glucose and 7 other metabolic fuels were measured by micro enzymatic assays and serum insulin by radioimnunoassay. Severity of surgery was scored using the Oxford surgical stress scale (SSS).
Surgery caused significant increases in the concentrations of lactate, pyruvate and ketone bodies which vrere related to SSS (tau=0.34 (p<0.01), 0.34 (p<0.01), 0.26 (p<0.01) respectively) but not to age. Increases in blood glucose and insulin were also related to SSS (tau=0.20 (p<0.05), 0.21 (p<0.05); older children tended to have slightly less increase in blood glucose (tau=-0.19, p < 0.05) and much higher preoperative insulin concentrations (tau=0.47 p<0.001). Total gluconeogenic substrate concentrations were markedly depressed 24 hours after surgery; this was well predicted by SSS (tau=-0.43 p<0.01) but not by age.
The metabolic response of children to surgery, though different from both adults and neonates is stable over a wide age range. The Oxford scale predicts the degree of metabolic displacement due to surgery and may thus prove a useful instrument in trials of anaesthesia and analgesia in infants and children.
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Ward Platt, M., Tarbit, M. & Aynsley-Green, A. The effect of age and severity on the metabolic response to surgery in infancy and childhood. Pediatr Res 22, 233 (1987). https://doi.org/10.1203/00006450-198708000-00119
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DOI: https://doi.org/10.1203/00006450-198708000-00119