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Surgical stress and neuroendocrine responses in infants and children
W Rosendahl1, U Schulz, T Teufel
1Department II of Paediatrics, Children's Hospital, Tübingen, Germany.
Insights
Routine surgery in children significantly elevates stress hormones like ACTH and cortisol, with beta-endorphin and arginine-vasopressin also increasing transiently. Hormone levels normalized the day after surgery.
Area of Science:
- Pediatric Surgery
- Neuroendocrinology
- Stress Response
Background:
- Surgery in infants and children can induce significant physiological stress.
- Understanding the neuroendocrine response is crucial for managing pediatric surgical patients.
Purpose of the Study:
- To investigate the plasma levels of key stress hormones following routine surgery in pediatric patients.
- To determine the correlation between different stress hormones during the perioperative period.
Main Methods:
- Measurement of plasma ACTH, cortisol, beta-endorphin, and arginine-vasopressin (AVP) in 42 children.
- Hormone levels were assessed before surgery, 60-90 minutes after skin closure, and the day after surgery.
- Anesthesia was maintained with halothane and nitrous oxide.
Main Results:
- Increased levels of ACTH and cortisol were observed post-surgery in most patients.
- Beta-endorphin levels rose significantly and correlated with ACTH.
- A marked increase in AVP was noted in 84% of subjects, suggesting a potent stress response beyond osmotic or cardiovascular factors.
- All measured stress hormone levels returned to normal by the day after surgery.
Conclusions:
- Routine surgical procedures in infants and children elicit a substantial, yet temporary, activation of neuroendocrine stress hormones.
- The findings highlight the significant impact of surgery on the pediatric stress response system.
Abstract:
We studied the stress hormone response to surgery in 42 infants and children. Plasma levels of the stress hormones ACTH, cortisol, beta-endorphin and arginine-vasopressin (AVP) were determined on three occasions, i.e., one day before surgery, 60 to 90 minutes after skin closure and on the day after surgery (anesthesia by halothane and nitrous oxide). We observed an increase in the levels of both ACTH and cortisol in most patients after surgery, although there was no correlation between them. Beta-endorphin levels, on the other hand, rose after surgery and correlated significantly with ACTH in 30 patients. A steep rise in AVP levels was found in 84% of the subjects, a phenomenon that could not have been due only to osmotic or cardiovascular stimuli. The values of all the stress hormones declined and normalized on the day after surgery. We conclude that routine surgery in infancy or childhood induces a dramatic, albeit transient, stimulation of neuroendocrine stress hormones.