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