Yang et al. investigated the effect of sedation on cortisol secretion, a factor not commonly thought to affect the biochemical outcome of AVS. That the reduction in cortisol secretion was observed after a very low dose of sedation medication is especially concerning. The number of patients in this retrospective study is low to be sure, requiring confirmation by larger studies. Nonetheless, the effect on the cortisol level is too significant to ignore, and the results are echoed by other studies.