Characterization of the Cortisol Stress Response to Sedation and Anesthesia in Children
Abstract
Context The cortisol stress response to sedation and anesthesia in children is not well characterized. It is not clear whether it is necessary to give stress doses of corticosteroids to children with adrenal insufficiency undergoing sedated procedures. Objective Our objective was to describe the cortisol stress response to sedation and anesthesia in normal children. Design, setting, and patients This was a prospective cohort study of 149 children ages 1 month to 17 yr who presented for routine sedated procedures. Salivary cortisol was measured at baseline, every 30 min during procedures, at completion, and at recovery. Main outcome measures We evaluated relative change in salivary cortisol from baseline for level of sedation achieved and type of procedure performed. Results In total, 117 patients had adequate samples collected, and 110 were included in the main analysis. Twenty-five percent of patients showed an increase in salivary cortisol greater than four times baseline, consistent with a stress response. Mean salivary cortisol increased more than 3-fold from baseline (3.7±0.4, P Conclusion Sedation and anesthesia can induce a significant rise in cortisol in children. Additional studies should be performed to validate our results and to determine whether stress dosing of corticosteroids may be needed for children with adrenal insufficiency undergoing sedated procedures.
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Studies provide evidence for an endogenous increase in cortisol during anesthesia, surgery, trauma, and critical illness, with great interindividual variation.
“Studies provide evidence for an endogenous increase in cortisol during anesthesia, surgery, trauma, and critical illness, with great interindividual variation (137-141).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [140]
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- Authors
- Hsu, A. A., von Elten, K., Chan, D., Flynn, T., Walker, K., Barnhill, J., Naun, C., Pedersen, A. M., Ponaman, M., Fredericks, G. J., Crudo, D. F., & Pinsker, J. E.
- Affiliations
- Tripler Army Medical Center (US)
- Defense Center for Public Health - Aberdeen (US)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Pinsker, Jordan E.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-10
- Volume
- 97
- Issue
- 10
- Pages
- E1830-E1835
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1971935787
- Cited by
- 45
- References
- 18
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 6 · 2014: 1 · 2013: 2
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- cortisol stress response, pediatric sedation, pediatric anesthesia, salivary cortisol, adrenal insufficiency, sedation depth, children
- MeSH terms
- Adolescent, Adrenal Cortex, Adrenal Cortex Hormones, Anesthetics, Child, Child, Preschool, Female, Humans, Hydrocortisone, Hypnotics and Sedatives, Infant, Infant, Newborn, Male, Prospective Studies, Reference Values, Saliva, Stress, Physiological, Minor Surgical Procedures
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