title: The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol.
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Department of Anaesthesia, Skaraborg Hospital, Skövde, Sweden. berith.wennstroem@telia.com
authors.forename: Berith
authors.initials: B
authors.lastname: Wennström
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Törnhage
authors.forename: Salmir
authors.initials: S
authors.lastname: Nasic
authors.forename: Hans
authors.initials: H
authors.lastname: Hedelin
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bergh
mesh_terms: D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009719:Nurse Anesthetists; D010147:Pain Measurement; D017060:Patient Satisfaction; D019990:Perioperative Care; D016528:Postanesthesia Nursing; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012463:Saliva / Q000378:metabolism*; D013315:Stress, Psychological / Q000517:prevention & control*; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D006854:Hydrocortisone