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    Anxiety and Salivary Cortisol Levels in Children Undergoing Esophago-Gastro-Duodenoscopy Under Sedation
    (Lippincott Williams & Wilkins, 2019) Kara, Duygu; Bayrak, Nevzat Aykut; Volkan, Burcu; Ucar, Cihat; Cevizci, Mehmet Nuri; Yildiz, Sedat
    Objectives: Esophagogastroduodenoscopy (EGD) can cause fear and anxiety in children. Cortisol, which is the most important glucocorticoid hormone in humans, can increase under physiological stress. The purpose of this study was to measure the salivary cortisol level (SCL) and anxiety level in patients undergoing EGD and evaluate their effects on the procedure. Methods: Children undergoing EGD under sedoanalgesia with propofol for various reasons were included. Their basal SCLs were compared with those of healthy age- and sex-matched controls. Moreover, SCL of the patient group at 30 minutes before EGD and 2 hours after the procedure were measured. Their anxiety scores were calculated using the modified Yale Preoperative Anxiety Scale before EGD. Duration of endoscopy, sedation, and recovery and total propofol doses were recorded. Results: Demographic properties of the patient group (n = 119; 10.9 +/- 3.2 years; 43.7% boys) and control group (n = 85; 11.8 +/- 2.8 years; 45.1% boys) were not significantly different. Basal SCLs of both groups were similar (16.9 +/- 0.7 vs 19.7 +/- 1.8 ng/mL, P = 0.16). SCL before EGD in the patient group was significantly higher than basal and post-EGD values (P < 0.001 for each). Pre-EGD SCL was positively correlated with anxiety level, propofol dose, and duration of sedation, procedure, and recovery. Anxiety levels of patients were positively correlated with propofol dose and duration of sedation and recovery, and negatively correlated with age. Conclusions: Childhood EGD is a significant stress factor, which was reflected by the pre-procedural SCL in this study. Increased anxiety resulted in increased propofol doses and sedoanalgesia-related procedural durations, which may cause potential complications.
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    Preparatory information reduces gastroscopy-related stress in children as confirmed by salivary cortisol
    (Wolters Kluwer Medknow Publications, 2019) Volkan, Burcu; Bayrak, Nevzat Aykut; Ucar, Cihat; Kara, Duygu; Yildiz, Sedat
    Background/Aims: This study aimed to determine whether the anxiety levels of pediatric patients who undergo endoscopy are reduced after receiving preparatory information about the endoscopic procedure by monitoring their salivary cortisol (s-cortisol) levels. Patients and Methods: A total of 184 children undergoing gastroscopy under sedoanalgesia were induded in the study. All the patients received a brief explanation of the endoscopic procedure. Patients were divided into two groups; Group Unexplained did not receive any further information other than a brief explanation of the procedure, Group Explained received more detailed explanation of the procedure. To determine anxiety levels, saliva specimens were taken on the day before the procedure to examine cortisol levels before and after endoscopy. Anxiety scores before endoscopy were calculated by the modified Yale Preoperative Anxiety Scale. Patients were monitored throughout sedoanalgesia, induding during the endoscopy, sedation and recovery, and total propofol dosages were recorded. Results: Eighty-nine children undergoing gastroscopy (age 11.55 +/- 252 years; 50.596 girls) constituted Group Explained and 95 children undergoing gastroscopy (age 11.44 +/- 2.66 years; 56.896 male) constituted Group Unexplained. The anxiety score, duration of sedation, endoscopy and recovery, propofol dose, pre- and post-endoscopy s-cortisol levels were significantly reduced in Group Explained. Conclusions: We demonstrated that when endoscopic procedure is explained broadly to a child, the procedural stress is significantly less, as measured by the s-cortisol levels and the anxiety questionnaire. It is important for the attending physician to explain all aspects of examination carefully.