Relationship Between Preoperative Anxiety, Salivary Cortisol, Gastric Antrum Volume, and Postoperative Emergence Delirium in Preschool Children Undergoing Adenotonsillectomy

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.