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The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol
Author(s) -
Wennström Berith,
Törnhage CarlJohan,
Nasic Salmir,
Hedelin Hans,
Bergh Ingrid
Publication year - 2011
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2011.03656.x
Subject(s) - medicine , perioperative , hydrocortisone , anesthesia
Summary Aim: To evaluate the efficacy of ‘the perioperative dialogue (PD)’ by analyzing salivary cortisol, in 5‐ to 11‐year‐old children undergoing day surgery. Background: To deal with anxiety prior to investigations and/or procedures, children need to be confident and informed about what is going to happen. Therefore, intervention strategies should be initiated before admission to hospital. Methods and materials: Children ( n = 93), 79 boys and 14 girls, scheduled for elective day surgery requiring general anesthesia were randomly recruited into three groups: (i) standard perioperative care ( n = 31), (ii) standard perioperative care including preoperative information ( n = 31), and (iii) the PD ( n = 31). Saliva was sampled for cortisol analysis at specific time points during the pre‐ and perioperative procedures. Results: The children who received the PD had significantly lower ( P = 0.003) salivary cortisol concentrations postoperatively. Moreover, it continuously decreased during the day of surgery compared with the other two groups ( P < 0.01). Among the children who received analgesics, the PD group received significantly less morphine ( P = 0.014) related to bodyweight: the mean dose was 0.1 mg·kg −1 ( n = 9) in the control group vs 0.04 mg·kg −1 ( n = 6) in the PD group. Irrespective of group, there was a positive correlation between the children’s morphine consumption and salivary cortisol concentration ( r = 0.56; P = 0.038). The W‐B scale score was higher in the group that received morphine (median = 3 vs median=1; P = 0.001). Conclusions: The PD’s caring, continuity, and on‐going dialogues were associated with low concentrations of salivary cortisol postoperatively and reduced morphine consumption and thus appears to be a valuable complement to standard perioperative care in children undergoing day surgery.