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Minerva Anestesiologica 1999 July-August;65(7-8):499-505

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Clinical and hormonal response to general anaesthesia in patients affected by different degrees of mental retardation

Cavaliere F. 2, Cormaci S. 1, Cormaci M. 1, Proto A. 1, Alberti A. 3, Colabucci F. 3

1 IRCCS Oasi Maria SS, Troina (EN); 2 Department of Anaesthesiology and Intensive Care, Catholic University of the “Sacro Cuore” - Rome; 3 Department of Pediatrics, Catholic University of the “Sacro Cuore” - Rome


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Background. Poor or no clin­i­cal ­signs of psy­cho­log­i­cal dis­tress are usu­al­ly ­observed in ­patients affect­ed by ­severe or pro­found men­tal retar­da­tion (MR). The aim of ­this ­study was to use clin­i­cal and hor­mo­nal param­e­ters in ­order to com­pare the ­amount of ­stress in ­patients affect­ed by dif­fer­ent ­degrees of MR under­go­ing gen­er­al anaesthe­sia for den­tal ­care.
Methods. Nine ­patients affect­ed by ­mild or mod­er­ate MR (­group A: intel­lec­tive quo­tient > 35) and 12 affect­ed by ­severe or pro­found MR (group B: intel­lec­tive quo­tient < 36), under­go­ing gen­er­al anaesthe­sia for den­tal ­care, ­were stud­ied. The reac­tion to ven­i­punc­ture ­before anaesthe­sia induc­tion and the recov­ery ­from anaesthe­sia ­were ­assessed by clin­i­cal ­scores. Cardiac ­rate and arte­ri­al pres­sure ­were record­ed ­before and ­after ven­i­punc­ture and ­after remov­ing the endo­tra­cheal ­tube. Cortisol and pro­lac­tin, two hor­mones affect­ed by ­stress, ­were deter­mined in plas­ma the day ­prior to sur­gery (1), ­after anaesthe­sia induc­tion (2), and ­after remov­ing the endo­tra­cheal ­tube (3).
Results. During ven­i­punc­ture, ­group B was sig­nif­i­cant­ly ­less reac­tive ­than ­group A (p<0.05) and ­showed no arte­ri­al pres­sure ­increase ­while ­group A pre­sent­ed a sig­nif­i­cant ­increase of sys­tol­ic pres­sure; con­verse­ly, the ­groups ­shared the ­same hor­mo­nal pat­tern at ­time 2 (cor­ti­sol did not ­change, pro­lac­tin ­increased sig­nif­i­cant­ly). Postoperatively A and B ­groups did not dif­fer regard­ing car­diac ­rate and arte­ri­al pres­sure, ­while a wid­er ­range of post­op­er­a­tive ­scores was ­observed in ­group A in ­which a fur­ther pro­lac­tin ­increase was reg­is­tered at ­time 3.
Conclusions. Clinical eval­u­a­tion can under­es­ti­mate the ­stress to ­which ­patients affect­ed by ­severe or pro­found MR are sub­ject­ed dur­ing anaesthe­sia induc­tion.

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