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Characterization of the cortisol stress response to sedation and anesthesia in children

Angela A Hsu1, Kelley von Elten, Debora Chan

  • 1Department of Pediatrics, Mail Code MCHK-PE, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, Hawaii 96859-5000, USA.

The Journal of Clinical Endocrinology and Metabolism
|August 3, 2012
PubMed

Insights

Sedation and anesthesia can cause a significant cortisol stress response in children. Further research is needed to determine if corticosteroid stress doses are necessary for children with adrenal insufficiency undergoing these procedures.

Area of Science:

  • Pediatric endocrinology
  • Anesthesiology
  • Stress response research

Background:

  • The cortisol stress response in children undergoing sedation and anesthesia is not well understood.
  • The necessity of corticosteroid stress doses for pediatric patients with adrenal insufficiency during sedated procedures remains unclear.

Purpose of the Study:

  • To characterize the cortisol stress response to sedation and anesthesia in healthy children.
  • To provide data that may inform clinical decisions regarding corticosteroid use in pediatric patients with adrenal insufficiency.

Main Methods:

  • Prospective cohort study involving 149 children (1 month to 17 years) undergoing routine sedated procedures.
  • Salivary cortisol levels measured at baseline, during procedures (every 30 min), at completion, and during recovery.
  • Analysis focused on relative changes in salivary cortisol from baseline, considering sedation levels and procedure types.

Main Results:

  • A significant cortisol increase (over 3-fold from baseline) was observed in the majority of the 110 analyzed patients.
  • Twenty-five percent of patients exhibited a cortisol increase greater than four times baseline, indicating a stress response.
  • No significant differences in cortisol response were found based on sedation level or procedure type; peak levels often occurred post-procedure.

Conclusions:

  • Pediatric sedation and anesthesia can elicit a substantial cortisol elevation, indicative of a stress response.
  • Further studies are required to validate these findings and to ascertain the need for corticosteroid stress dosing in pediatric patients with adrenal insufficiency undergoing sedated procedures.
Abstract

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