Relationship Between Preoperative Anxiety, Salivary Cortisol, Gastric Antrum Volume, and Postoperative Emergence Delirium in Preschool Children Undergoing Adenotonsillectomy.
- 1Anesthesiology, Ankara Bilkent City Hospital, Ankara 06800, Turkey.
- 2Institut Mondor de Recherche Biomedicale IMRB, Paris-Est Créteil University, 94010 Créteil, France.
- 3Faculty of Medicine, Department of Otolaryngology, Head and Neck Surgery, Ankara Yıldırım Beyazıt University, Ankara 06010, Turkey.
Abstract
Background and Objectives: This study examined four pre-specified relationships in 47 preschool children (aged 4-7) undergoing adenotonsillectomy: the perioperative change in salivary cortisol in relation to postoperative emergence delirium (PAED) and pain (FLACC) scores, defined a priori as the primary endpoint, and, as secondary, hypothesis-generating endpoints, the associations between preoperative anxiety (mYPAS) and salivary cortisol, between cortisol and gastric antral cross-sectional area (CSA, used as a surrogate for gastric volume), and between intraoperative anesthesia depth (PSI) and PAED scores. Materials and Methods: Preoperative anxiety was assessed using the mYPAS scale, followed by salivary cortisol sampling and ultrasonographic measurement of the gastric antral cross-sectional area (CSA, used as a surrogate for gastric volume). Postoperative recovery was monitored using PAED and FLACC scoring systems at 0, 15, and 30 min. Results: A moderately strong positive correlation was identified between mYPAS anxiety scores and preoperative salivary cortisol levels. However, no statistically significant correlation was detected between preoperative cortisol and gastric antral CSA. Furthermore, linear mixed-effects modeling did not detect a statistically significant association between the change in cortisol levels and postoperative PAED scores. Conclusions: The study confirms that preoperative behavioral anxiety in children is reflected in physiological markers like salivary cortisol. However, no statistically significant association was detected between these cortisol levels and gastric antral CSA, postoperative emergence delirium, or postoperative pain (PAED/FLACC scores) in this cohort. While mYPAS remains a valid tool for assessing preoperative anxiety, our findings do not support cortisol or gastric antral CSA as reliable predictors of post-anesthesia outcomes in this pediatric population; larger studies are needed before concluding that no such relationship exists.
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BibTeX
@article{karacam2026relationship,
title = {{Relationship Between Preoperative Anxiety, Salivary Cortisol, Gastric Antrum Volume, and Postoperative Emergence Delirium in Preschool Children Undergoing Adenotonsillectomy.}},
author = {Alpay Karaçam and Cihan Döğer and Jan Berkehan Erkilic and Eda Uysal Aydın and Burak Celik and Fazilet Erbay and Bilge Tuncer and Handan Güleç and Ezgi Erkilic},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = oct,
doi = {10.3390/medicina62101945},
url = {https://europepmc.org/article/MED/42942476},
note = {CC BY},
}
RIS
TY - JOUR
TI - Relationship Between Preoperative Anxiety, Salivary Cortisol, Gastric Antrum Volume, and Postoperative Emergence Delirium in Preschool Children Undergoing Adenotonsillectomy.
AU - Alpay Karaçam
AU - Cihan Döğer
AU - Jan Berkehan Erkilic
AU - Eda Uysal Aydın
AU - Burak Celik
AU - Fazilet Erbay
AU - Bilge Tuncer
AU - Handan Güleç
AU - Ezgi Erkilic
PY - 2026
DA - 2026/10/08
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101945
UR - https://europepmc.org/article/MED/42942476
AB - Background and Objectives: This study examined four pre-specified relationships in 47 preschool children (aged 4-7) undergoing adenotonsillectomy: the perioperative change in salivary cortisol in relation to postoperative emergence delirium (PAED) and pain (FLACC) scores, defined a priori as the primary endpoint, and, as secondary, hypothesis-generating endpoints, the associations between preoperative anxiety (mYPAS) and salivary cortisol, between cortisol and gastric antral cross-sectional area (CSA, used as a surrogate for gastric volume), and between intraoperative anesthesia depth (PSI) and PAED scores. Materials and Methods: Preoperative anxiety was assessed using the mYPAS scale, followed by salivary cortisol sampling and ultrasonographic measurement of the gastric antral cross-sectional area (CSA, used as a surrogate for gastric volume). Postoperative recovery was monitored using PAED and FLACC scoring systems at 0, 15, and 30 min. Results: A moderately strong positive correlation was identified between mYPAS anxiety scores and preoperative salivary cortisol levels. However, no statistically significant correlation was detected between preoperative cortisol and gastric antral CSA. Furthermore, linear mixed-effects modeling did not detect a statistically significant association between the change in cortisol levels and postoperative PAED scores. Conclusions: The study confirms that preoperative behavioral anxiety in children is reflected in physiological markers like salivary cortisol. However, no statistically significant association was detected between these cortisol levels and gastric antral CSA, postoperative emergence delirium, or postoperative pain (PAED/FLACC scores) in this cohort. While mYPAS remains a valid tool for assessing preoperative anxiety, our findings do not support cortisol or gastric antral CSA as reliable predictors of post-anesthesia outcomes in this pediatric population; larger studies are needed before concluding that no such relationship exists.
SN - 1010-660X
SN - 1648-9144
ER -