STRESS HORMONAL RESPONSE AND METABOLIC ADAPTATION UNDER LOW-FLOW SEVOFLURANE ANESTHESIA IN CHILDREN UNDERGOING LAPAROSCOPIC VERSUS OPEN ENDOUROLOGICAL SURGERY: A PROSPECTIVE COMPARATIVE STUDY

Abstract

The magnitude of the surgical stress response in pediatric patients constitutes a critical determinant of perioperative morbidity, metabolic homeostasis, and postoperative recovery quality. Neuroendocrine activation elicited by surgical trauma manifests primarily through hypothalamic–pituitary–adrenal axis stimulation, resulting in measurable elevations of serum cortisol, secondary disruption of pancreatic insulin secretion, and peripheral tissue hypoperfusion reflected in elevated blood lactate concentrations. Children are particularly susceptible to stress-mediated hormonal dysregulation owing to the relative immaturity of hypothalamic regulatory mechanisms and limited glycogen reserves. Whereas minimally invasive endourological techniques are presumed to attenuate the magnitude of this neuroendocrine response compared to open surgery, objective biochemical evidence in the pediatric population under standardized low-flow volatile anesthesia remains sparse. Characterizing the dynamics of cortisol, insulin, and lactate across surgical modalities is therefore of direct clinical and scientific importance.