ABSTRACT
Premature infants are capable of mounting physiologic and metabolic responses to pain.
Systemic and local anesthesia reduce stress responses to major and minor surgical
procedures. We evaluated the effects of local anesthesia (5 mg/kg lidocaine) preceded
by either 1 mg/kg secobarbital (S) intravenously or by 2 μg/kg fentanyl (F) intravenously
on the stress response to Broviac catheter placement. Twenty-nine premature infants
ages 5 to 30 days, weighing between 650 and 1350 gm, were randomly assigned to either
S or F groups. Age, birthweight, sex, race, and severity of illness were similar among
S and F groups. Heart rate and blood pressure remained unchanged throughout the procedure.
Oxygen saturation (O2sat ) declined significantly in both groups during skin preparation and wound closure,
but not during incision, dissection, or tunneling. In spite of fractional inspired
oxygen adjustments made in 13 of 14 S-and 3 of 15 F-treated patients, decline in O2sat was more common and more pronounced (p <0.01) in S-treated babies. Hyper-glycemic
responses occurred in all S- and in none of the F-treated patients (p <0.001). Norepinephrine
plasma concentrations did not change during Broviac catheter placement in either F
or S group. Epinephrine concentrations were more elevated in S- than in F-treated
patients, although these differences were not statistically significant. Low-dose
fentanyl analgesia effectively complements local lidocaine anesthesia during Broviac
catheter placement. Sedatives neither abolish metabolic responses to surgical stress
nor prevent profound and persistent oxygen desaturation.
