Postoperative Pain and Stress Response: Does Child’s Gender Have an Influence?

Abstract

SUMMARYSurgical procedure causes multisystem stress response reactions. The aim of this study was to assess whether gender has an impact on the level of neuroendocrine response to surgical stress and intensity of postoperative pain in children undergoing inguinal hernia repair surgery, as well as satisfaction of their parents with preoperative and postoperative care. The study included 60 children aged 3-6 years, all of them the only child in the family. All children included in the study were categorized as American Society of Anesthesiologists PS Class I, and divided into two groups: group 1 composed of 30 boys and group 2 composed of 30 girls. After oral premedication with midazolam, general anesthesia with endotracheal intubation was performed in all patients. Ketorolac, 1 mg.kg-1, was administered for postoperative analgesia. Serum cortisol was measured in all children preoperatively and postoperatively. The quality of postoperative analgesia was evaluated by Wong-Baker (FACES) scale, along with parental satisfaction. Male children who were the only child in the family had stronger neuroendocrine response to surgical stress and stronger intensity of postoperative pain. The parents of the girls expressed greater satisfaction with preoperative and postoperative care.

Foreign Body Aspiration and Ingestion in Children

“…Foreign body aspiration is an urgent, potentially life-threatening state, as well as one of the leading causes of mortality and morbidity in children younger than three years ( 1 - 6 ). If suspected, a child aspirating a foreign body requires urgent medical evaluation ( 6 ).…”

“…Foreign body aspiration is an urgent, potentially life-threatening state, as well as one of the leading causes of mortality and morbidity in children younger than three years ( 1 - 6 ). If suspected, a child aspirating a foreign body requires urgent medical evaluation ( 6 ). It is of utmost importance to establish a diagnosis or even to suspect foreign body aspiration during first examination, according to the patient history, general state, and data received from the parents/guardians ( 6 ).…”

“…If suspected, a child aspirating a foreign body requires urgent medical evaluation ( 6 ). It is of utmost importance to establish a diagnosis or even to suspect foreign body aspiration during first examination, according to the patient history, general state, and data received from the parents/guardians ( 6 ). In fact, 85% of cases are diagnosed in time, but in 15% of aspirated foreign bodies that were diagnosed later on, develop complications such as pneumonia, atelectasis and abscesses ( 5 , 11 , 12 ).…”

“…Such cases demand quick recognition and treatment in order to avoid potentially lethal complications. Generally speaking, aspiration of foreign body is connected to high morbidity rates (10%-20%), and it is responsible for 7% of accidental deaths in children under three years of age ( 1 - 6 ).…”

Salivary cortisol as a biomarker of stress in surgical patients

“…Surgical stress and pain result in activation of hypothalamus-pituitary-adrenal (HPA) axis [8] . Stimulation of HPA axis leads to a production of corticotrophin-releasing factor (CRF) in the hypothalamus, which in turn stimulates adrenocorticotropic secretion by the hypophysis and leads to a consequent stimulation of adrenal gland cortex to release cortisol, one of the major glucocorticoids [9] [10] .…”