Evaluating perioperative stresses in children by noninvasive modalities using salivary cortisol and autonomic reactivity

Topic overview

Key takeaways

• 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.

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