[Surgical stress and hypophyseal-adrenal activation in childhood].

INTRODUCTION: The study on the physiological alterations due to surgical aggression (surgical stress), widely investigated in adults, is less known in paediatric age.

THE OBJECTIVE: Of this work is to quantify surgical stress (evaluated by means of Oxford Scale as high or low depending on its value bigger or lower than 6), after determining changes of plasmatic concentrations of ACTH, beta-endorphin and cortisol in operated children.

PATIENTS AND METHODS: Observational analytic design of a prospective cohort with internal comparison of the groups.

SAMPLE SIZE: 33 (age 10 +/- 2.6 years; range 5 to 14 years).

DEPENDENT VARIABLES: plasmatic concentrations of ACTH, beta-endorphin and cortisol determined before and after the intervention (1 and 24 hours after surgery), by radio-immune-analysis.

RESULTS: Significative increase of the three considered hormones one hour after surgery, with decrease of them until preoperative levels 24 hours later. Significative correlation between beta-endorphin (24 hours after surgery), cortisol (1 hour after surgery) and surgical stress levels.

CONCLUSIONS: Surgery in children provokes the activation of hipophysal-suprarrenal system. These levels early came back to normal ones, 24 hours after surgery. There is a specific change in beta-endorphin, that is why it is possible to assure that beta-endorphin is a "stress-hormone", since it is affected by surgical aggression. Cortisol seems to be a good index of level of surgical stress.