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Evaluating perioperative stresses in children by noninvasive modalities using salivary cortisol and autonomic
Ayaka Adachi1, Kentaro Fujiwara1, Hiroko Watayo1
1Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Insights
Perioperative stress in children, measured by salivary cortisol (SalC) and low to high pulse ratio (LHR), was linked to pain. Caregiver presence significantly reduced stress levels during recovery.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Pain Management
Background:
- Perioperative stress in children is a significant concern impacting recovery.
- Salivary cortisol (SalC) and low to high pulse ratio (LHR) are potential biomarkers for assessing this stress.
Purpose of the Study:
- To evaluate perioperative stress in pediatric patients using SalC and LHR.
- To correlate these stress markers with patient demographics, surgical factors, and pain scores.
Main Methods:
- Children aged 6 months to 16 years undergoing elective surgery had saliva collected pre- and post-operatively.
- SalC and LHR were measured and analyzed using mixed-effects models, correlating with age, sex, operative time, surgical approach, and pain ratings (FRS/NRS).
Main Results:
- Postoperative SalC levels increased significantly and returned to baseline by 3 days after surgery.
- SalC correlated positively with operative time, open surgery, and pain scores, but negatively with age and caregiver attendance.
- LHR showed a slight increase and correlated positively with age, female sex, and caregiver attendance.
Conclusions:
- Salivary cortisol levels are indicative of perioperative stress and correlate with perceived pain in children.
- Caregiver attendance plays a crucial role in alleviating pediatric surgical stress.
Purpose:
Salivary cortisol (SalC) and low to high pulse ratio (LHR) were used for evaluating perioperative stresses in children.
Methods:
Children aged 6 months-16 years having elective general (thoracic/abdominal) or minor (open/minimally invasive: MI) procedures underwent pulse monitoring during AM (08:00-12:00) and PM (17:00-21:00) saliva collections from the day before surgery (S-1) to 3 days after surgery (S + 3). SalC/LHR were correlated with age, sex, caregiver attendance, operative time, and surgical site/approach using mixed model analysis and face/numeric pain rating scales (FRS/NRS).
Results:
Mean ages (years): minor-open (n = 31) 4.7 ± 2.0, thoracic-open (n = 2) 8.7 ± 4.9, thoracic-MI (n = 6) 9.6 ± 6.1, abdominal-open (n = 14) 4.3 ± 4.1, and abdominal-MI (n = 32) 8.0 ± 5.0. Postoperative SalC increased rapidly and decreased to preoperative levels by S + 3 (p < 0.001). LHR increased slightly without decreasing (p = 0.038). SalC correlated positively with operative time (p = 0.036) and open surgery (p = 0.0057), and negatively with age (p < 0.0001) and caregiver attendance (p < 0.001). SalC correlated positively with FRS (n = 51) at S + 2(PM) (p = 0.023), S + 3(AM) (p < 0.001), S + 3(PM) (p = 0.012) and NRS (n = 34) at S + 1(AM) (p = 0.031), S + 3(AM) (p < 0.044). LHR positively correlated with age (p = 0.0072), female sex (p = 0.0047), and caregiver attendance (p = 0.0026). Postoperative SalC after robotic-assisted MI was significantly lower than after open surgery at S + 2(AM) (p = 0.020).
Conclusions:
SalC correlated with pain. Caregiver attendance effectively alleviated stress.
