Heart Rate Variability and Early Cytokine Profile in Pediatric Adenotonsillectomy

Eligible children aged 5 to 9 years with ASA physical status I-II who are scheduled for elective adenoidectomy, tonsillectomy, or adenotonsillectomy will be enrolled consecutively after parental written informed consent. Standard clinical care will not be altered. HRV will be obtained using Holter/ECG monitoring and analyzed using time-domain (SDNN, RMSSD) and frequency-domain (LF, HF, LF/HF) measures. Standard intraoperative monitoring, Bispectral Index, and routine anesthetic management will be recorded. A residual 3 mL venous blood specimen collected at 5 minutes after intubation and before incision will be processed for IL-6, IL-8, IL-1, IL-1 beta, TNF-alpha, and IL-10 by ELISA. Postoperative emergence delirium will be evaluated with the Pediatric Anesthesia Emergence Delirium scale. Perioperative respiratory and cardiac adverse events will be prospectively documented until discharge from the PACU.

Inclusion criteria

• Age 5-9 years;
• elective adenoidectomy, tonsillectomy, or adenotonsillectomy operation
• ASA physical status I-II;
• surgery planned under general anesthesia;
• able to undergo standard endotracheal intubation and standard anesthetic protocol

-; no dermatologic or cardiac barrier to preoperative Holter monitoring;

• written informed consent provided by parent/legal guardian.

Exclusion criteria

• ASA physical status III or higher; congenital heart disease, arrhythmia, or cardiac conduction disorder;
• known neurologic disease (e.g., epilepsy or cerebral palsy);
• psychiatric diagnosis;
• chronic inflammatory or immune-system disease;
• acute infection within 2 weeks before surgery
• regular steroid, immunosuppressive, or anti-inflammatory medication use;
• endocrine disease such as uncontrolled thyroid disease;
• preoperative hemodynamic instability;
• major unexpected intraoperative complication or ICU requirement;
• intraoperative atropine, lidocaine, beta-blocker, or epinephrine use;
• history of prematurity or syndromic disease;
• parent/legal guardian declines consent.