Is Anaesthesia Essential For Circumcision In Neonates

Thirty male neonates that were clinically free had been included in this study and were divided into three groups.Group I : Included ten male neonates undergoing circumcision without anaesthesia.Group II : Included ten male neonates undergoing circumcision under general anaesthesia (open nitrous 60% - 50% oxide in oxygen and flouthane).Group III : Included ten male neonates undergoing circumcision under spinal analgesia.All neonates were clinically free and neither of those neonates had systemic diseases nor were taking regular or any pre-operative medication.Maintenance fluid was given 5% (5% glucose) and fluid deficits of fasting hours (2 hours) were replaced. Heart rate, non invasive arterial blood pressure, end tidal CO2 and O2 saturation were monitored throughout the operation time and postoperative period. Venous bloodsamples (4 ml) were taken preoperatively and immediately at the end of the surgery. Samples were centrifuged and plasma was tested for glucose and lactate levels which was measured within 24 hours. Serum was stored at - 70°C till assayed for cortisol and insulin. After statistical analysis we came a cross the following results :1. Hemodynamics :There was a significant increase in heart rate and blood pressure in group (1) (circumcision without anaesthesia) at the end of surgery more than preoperatively and there was slight increase in heart rate and decrease in blood pressure in group II (circumcision under general anaesthesia) more than pre-operatively, and a decrease in heart rate and blood pressure in group III was less than in the other two groups and the decrease was non significant and there was no percentage change in heart rates or mean systemic arterial blood pressure at the end of the surgery more than preoperatively in group (III).II. Hormonal changes : 1. Cortisol level:There was a significant increase in cortisol level at the end of the surgery in group (I) (circumcision without anesthesia) more than preoperatively and there was significant increase in cortisol level at the end of the surgery more than preoperatively in group (II) (circumcisionusing general anaesthesia), but the increase in cortisol level at the end of the surgery more than preoperatively in group (III) (circumcision under spinal anaesthesia) was less than that of the other two groups and the results of percentage changes were the same in the three groups.2. Insulin level:There was a significant increase in insulin level in the immediate postoperative period in group (I) (circumcision without anaesthesia) more than preoperatively and there was significant increase in the insulin level in group ”II” (circumcision using general anaesthesia) at the end of the surgery more than preoperatively but in group ”III” the decrease in insulin level at the end of the surgery was more than preoperatively but less than that of the other two groups. In this group of spinal anaesthesia showed that eight neonates had slight decrease in the insulin level post operatively (at the end of the surgery) and two neonates had slight increase in insulin level at the end of the surgery more than preoperatively and the percent of change was the same in the three groups.III. Metabolic changes : 1. Blood glucose level :There was a significant Increase In neonates of group (I) (circumcision without anaesthesia) for blood glucose level at the end ofthe surgery more than pre-operatively and also there was significant increase in blood glucose level in neonates of group (II) that were anaesthetized with general anaesthesia at the end of circumcision more than pre-operatively. But, there was slight decrease in blood glucose level at the end of the surgery in neonates of group III that were anaesthetized by spinal anaesthesia more than preoperatively, but this slight decrease was less than that of the other two groups, and there was no significant decrease and the percent change was like above in the 3 groups.2. Blood lactate level :There was a significant increase in blood lactate level at the end of the circumcision in neonates that were circumcised without anaesthesia. Also, there was significant increase in blood lactate level at the end of circumcision more than preoperatively in group (II) in which the neonates were circumcised using general anaesthesia.But, the increase in blood lactate level in group III neonates that were circumcised using spinal anaesthesia at the end of the surgery was less than that of the other two groups and there was increase in some neonates but more than normal level, so the increase was minimal and there was no significant increase and the percentage change was the same in the 3 groups.We can conclude that:(1) The present study has confirmed prevIOUS observations that neonates showed substantial metabolic and endocrine stress response.(2) It can be recommended that greater attention should be paid to using optimum analgesia and proper anaesthesia in neonates undergoing not only operations but also other invasive medical procedures during intensive care.