Responses of salivary cortisol levels and sedation score to oral hydroxyzine premedication in children undergoing outpatient surgery

Abstract

Aim: To evaluate the sedation score response and salivary cortisol levels (SC) to premedication with sedative hydroxyzine in children with outpatient surgery and the relationships between the two. Methods: Eighty-seven ASA 1 classified patients (American Society of Anesthesiologists Classification 1, normal healthy patients), aged 4-13 years, were randomly and prospectively allocated into the study. Children having outpatient surgery (e.g. inguinal/abdominal surgery, circumcision) either did not have a premedication or received oral hydroxyzine (2 h before the surgery) as a sedative drug. All patients were evaluated for the level of sedation by Ramsay sedation score [RSS, from 1 (awake, anxious, restless or both) to 6 (asleep, exhibits no response)] by an independent anesthesiologist. Salivary samples taken during the assessment of sedation score were analyzed for cortisol levels. Results: SC increased significantly by increasing age (r=0.447; p<0.001). Premedication with hydroxyzine produced higher sedation scores (1.73 vs 1.46, p=0.014) and patients with higher sedation scores had lower SC (p<0.01). Circumcised children had similar SC to hernia/inguinal surgery (p>0.05). Conclusion: The data suggest that salivary cortisol increases by increased age and provide evidence that sedation is associated with suppressed cortisol levels. Moreover, different types of surgery appear to be perceived as similar threats by the children.