Evaluation of the changes in the energy and the hemodynamic parameters in pediatric patient during general anesthesia

The children who need to be treated under general anesthesia because of their behavioral problems or disabilities holds an important place in Paediatric dentistry. At this point, dental treatments performed under general anesthesia and local anesthesia combination bring about some responsibilities. Child might get surgical trauma during their dental treatments and this trauma may cause some damages to the organism proportional to the severity of the trauma (restoration, amputation, tooth extraction). Specified trauma and 3 hours preoperative starvation causes a stress response in the child. Also expectations from surgery, fear of feeling pain and being apart from their families (with behavioral problems and disabilities) generate varying degrees of anxiety depending on the age and growth level of the child. The present also may cause additional stress to the child.Perioperative tissue damage is characterized by the neuroendocrine stress response. Response to the damage is seen by the increase in catecholamines, cortisol, glucagon, thyroxin, angiotensin, aldosterone, growth hormone, adrenocorticotropic hormone, antidiuretic hormone and thyroid stimulating hormone. Insuline hormone decreases at the beginning, but depending on the increase in growth hormone, the amount of insuline hormone may also increase. Blood sugar levels increase because of the decrease in insuline hormone levels.The ASA class I children with co-operation problems and the ASA class II children with disabilities among the patients who visited to the Paediatric Dentistry Department of Yeditepe University Dental Faculty for their dental treatments were chosen for this study. The study group included 30 patients appropriate for study criteria mentioned above who were randomly selected from February 2009 till April 2010. İnformed consents were received medical and dental history were taken from the parents of the patients included in the study. Patients were randomly divided into two groups (no:15). Group A is composed of children who were ASA class I and had behavioral problems during the dental treatments. Group B is composed of children who were ASA class II with mental retardation and disabilities.In the course of the operation heart rates, systolic, diastolic and mean arterial blood pressures, peripheral temperatures and blood sugar levels of child were measured at certain times under stabilized amount of oxygen during inspirium and carbondioxide during expirium (35% - 40%) meanwhile providing the appropriate alveolar ventilation.Hemodynamic parameters, peripheral temperatures and blood sugar levels were measured at begining, 30th, 60th minutes and at the end of the operation performed under general anesthesia. Blood sugar levels were measured with the aid of a digital glucose meter (SmartScan?, Lifescan, Johnson&Johnson Co, Milpitos, CA, USA). According to the acquired measurement values, changes in the metabolism of the child patient by stress response which had arised on the patients treated under general and local anesthesia combination were evaluated in terms of hemodynamic parameters, peripheric temperatures and blood sugar levels.In the present study, overall heart rate means of Group A were found statistically significantly higher compared to Group B. Systolic arterial blood pressure means of Group B at the end of operation were found statistically significantly higher compared to Group A. Peripheric temperature means of Group A at the end of the operation were found statistically significantly higher than Group B.Overall blood sugar level means during the whole general anesthesia procedure among Group A showed statistically significant differences. Blood sugar levels at the beginning of the operation were statistically significantly lower compared to the end of the operation. Blood sugar level means at the end of the operation were found statistically significantly higher compared to 60th minute blood sugar level means. Any statistically significant differences was observed between the other times.Overall blood sugar level means during the whole general anesthesia procedure among Group B showed statistically significant differences. Blood sugar level means at the beginning of the operation were found statistically significantly lower compared to the blood sugar level means of 60th minute and the end of the operation. Any statistically significant differences was observed between the other times.Heart rate levels of overall general anestesia procedure and local anesthesia of both groups showed statistically significant relationship.Diastolic arterial blood pressure levels at the beginning of the operation and total operation values of Group B were statistically significantly related.Blood sugar levels at the end of the operation and during local anesthesia of Group A showed positive statistically significant relation.In conclusion, during the dental treatment procedures performed under general anesthesia, monitorization of vital findings such as hemodynamic parameters, peripheric temperature and blood sugar level is extremely important. In terms of the health of the child patient, parameters mentioned above have to be controlled not only pre- and post-operative period but also in the perioperative period.Key Words: General anesthesia, hemodynamic parameters, blood sugar, local anestkhesia, stress