Influence of premedication on plasma acth and cortisol concentrations in children during adenoidectomy

Abstract

Summary: The endocrine response to stress, as reflected by the plasma concentrations of ACTH and cortisol, was investigated in 14 children receiving two different premedications during halothane anaesthesia for adenoidectomy. Seven children (group A) were premedicated with diazepam 5mg rectally and atropine 0.3-0.4mg sublingually and seven (group B) received a rectal combination of diazepam O.5mgkg-1, morphine 0 15mgkg-1 and hyoscine 0.01 mg kg-1. Before and after surgery plasma concentrations of ACTH and cortisol were lower in group B than in group A. In group A mean values for ACTH increased from 4O.7nglitre-1 before adenoidectomy to 352.9 nglitre-1 (P<0.001) after adenoidectomy. The corresponding increase in group B was from 12.1 nglitre-1 to 82.1 nglitre-1 (P<0.01). In group A mean cortisol concentrations increased from 235.7 nmol litre-1 to 655.7 nmol litre-1 after adenoidectomy (P< 0.001) and in group B from 121.4 nmol litre-1 to 427.9nmol litre-1 (P<0.01). End-tidal carbon dioxide tension was approximately the same in both groups. It was concluded that the combination of diazepam, morphine and hyoscine decreased the endocrine response to stress © 1982 The Macmillan Press Ltd.