Evaluating perioperative stresses in children by noninvasive modalities using salivary cortisol and autonomic reactivity
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In brief
In brief
This study validates noninvasive biomarkers—salivary cortisol and pulse variability—for measuring surgical stress in children aged 6 months to 16 years. Results show cortisol levels correlate with pain scores and operative factors, while caregiver presence significantly reduces stress responses across all surgical approaches.
- Salivary cortisol peaks postoperatively and returns to baseline by day 3, correlating with operative time and open vs minimally invasive approach.
- Younger children show higher salivary cortisol responses to surgery; robotic-assisted procedures produce lower stress markers than open surgery.
- Caregiver presence significantly reduces perioperative stress as measured by salivary cortisol levels.
- Salivary cortisol correlates with pain scores on postoperative days 1-3, validating it as a noninvasive stress biomarker in pediatric surgery.
- Low-to-high pulse ratio increases postoperatively without returning to baseline, suggesting prolonged autonomic dysregulation after pediatric surgery.
Written by the GCMD Library team from the article.
Abstract
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.