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Webb AR, Kalam I, Lui N, Loughnan RM, Leong S. A pre and post interventional audit of an 'apple juice on arrival' protocol to reduce excessive clear fluid fasting times in paediatric patients. Anaesth Intensive Care 2024:310057X241263112. [PMID: 39212180 DOI: 10.1177/0310057x241263112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Many studies have reported prolonged fasting times in children, associated with negative metabolic and behavioural outcomes. We felt that although our paediatric preoperative clear fluid fasting guideline was only for 2 hours, prolonged fasting still occurred for some patients. We conducted an audit of paediatric fasting times, before and after introducing a new protocol of 'apple juice on arrival', in which, on arrival to the children's ward, all children received 3 ml/kg of apple juice. Data were collected prospectively from patients and their parents for two 4-week periods (before and after introduction of the protocol). Data included fasting time (solids and clear fluids), capillary blood glucose levels, knowledge of fasting requirements and sources of fasting information before surgery. Thirty-nine and 40 children, respectively, were included in each group before and after protocol introduction. Clear fluid fasting times reduced from an average of 9.9 hours pre-intervention to 3.5 hours post intervention (P < 0.01). In addition, mean preoperative blood sugar levels increased from 4.9 mmol/L (pre-intervention group) to 5.6 mmol/L in the post-intervention group (P < 0.001). The implementation of an apple juice on arrival protocol appeared to be an effective method to reduce clear fluid fasting times in children in our institution.
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Affiliation(s)
- Ashley R Webb
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ikram Kalam
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
| | - Nicholas Lui
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
| | - Rachael M Loughnan
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Samuel Leong
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
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Pentz B, Patel P, Pilkington M, Daodu O, Lam JYK, Howlett A, Stephen L, Spencer A, Unrau J, Theam M, Brindle ME. Optimizing Implementation of the Neonatal Enhanced Recovery After Surgery Guideline. J Pediatr Surg 2024:S0022-3468(24)00406-8. [PMID: 39068053 DOI: 10.1016/j.jpedsurg.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/14/2024] [Accepted: 06/29/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS®) protocols require multidisciplinary team engagement from healthcare professionals (HCPs), where limited studies exist on neonatal ERAS®protocols. Therefore, we aimed to capture perceptions of HCPs on facilitation and implementation of the neonatal ERAS®guideline. METHODS 10 neonates were recruited. 13 HCPs involved in these patient's care were interviewed and 8 surveyed consisting of pediatric anesthesiologists, neonatologists, neonatal intensive care unit (NICU) registered nurses (RNs), and pediatric surgeons. Using a multi-methods design, recruitment, semi-structured interviews and surveys were conducted from May 17, 2021 to November 1, 2022. Data was coded using The Promoting Action on Research Implementation in Health Studies and then thematically analyzed. RESULTS Interviews were conducted with 4 pediatric anesthesiologists, 4 neonatologists, 2 NICU RNs, and 3 pediatric surgeons and surveys with 1 pediatric anesthesiologist, 2 neonatologists, 3 NICU RNs, and 2 pediatric surgeons. From interviews, the top 3 facilitation strategies were utilization of: (1) multidisciplinary guideline champions, (2) reminders and education, and (3) results to facilitate adherence. Incorporation of these strategies resulted in perceived: (1) stronger buy-in and engagement and (2) improved team communication, job satisfaction, care quality, and parental involvement. CONCLUSION HCPs stressed the importance of guideline champions, reminders and education, and results distribution. Given implementation during the COVID-19 pandemic, awareness and education were mixed. Nonetheless, HCPs perceived improved buy-in and engagement, communication, job satisfaction, quality of care, and parental involvement. Incorporation of these strategies can promote successful ERAS® guideline facilitation and implementation and should be considered for future ERAS® projects. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brandon Pentz
- Department of Surgery, University of Calgary, Calgary, AB, Canada.
| | - Palak Patel
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Mercedes Pilkington
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Oluwatomilayo Daodu
- Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Pediatric Surgery, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jennifer Y K Lam
- Division of Pediatric Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada
| | - Alexandra Howlett
- Department of Neonatology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Lori Stephen
- Department of Neonatology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Adam Spencer
- Department of Anesthesia, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jennifer Unrau
- Department of Neonatology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Michelle Theam
- Department of Anesthesia, Alberta Children's Hospital, Calgary, AB, Canada
| | - Mary E Brindle
- Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Pediatric Surgery, Alberta Children's Hospital, Calgary, AB, Canada
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Herbinger LA. Children and the Opioid Crisis: We Can Make a Difference. J Perianesth Nurs 2024:S1089-9472(24)00049-2. [PMID: 38703178 DOI: 10.1016/j.jopan.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/06/2024]
Abstract
The use of opioid-sparing and opioid-free strategies in children can provide adequate analgesia while decreasing the risk of adverse events and contributing to the ongoing battle against the opioid crisis. However, every child must be evaluated individually so that a safe and efficacious perioperative pain management plan can be created. A working knowledge of the risks and benefits of opioids, nonopioid adjuncts, and regional anesthesia along with the ethical considerations for balancing stewardship and beneficent care is essential to the success of these strategies. As perioperative practitioners caring for children, we have an obligation to consider opioid-sparing and opioid-free strategies to promote overall best outcomes. We can make a difference, one child at a time.
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Affiliation(s)
- Lisa Allison Herbinger
- Department of Nurse Anesthesia, Samford University, Birmingham, AL; Department of Anesthesia, Children's of Alabama, Birmingham, AL.
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Saravagol VM, Alladi A, Mamatha B. Safety and Feasibility of Enhanced Recovery after Surgery in Pediatric Colostomy Closure. J Indian Assoc Pediatr Surg 2024; 29:266-270. [PMID: 38912032 PMCID: PMC11192250 DOI: 10.4103/jiaps.jiaps_245_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 06/25/2024] Open
Abstract
Aims To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure. Materials and Methods Retrospective observational study of children who underwent colostomy closure. Data were collected from the electronic medical records and telephonic follow-up calls of patients from October 2013 to October 2023, in the Department of Pediatric Surgery of a Tertiary level Medical College. The parameters obtained were age, gender, type of stoma, primary diagnosis, discrepancy in luminal diameters, time to reach full feeds, postoperative hospital stay, and complications. The protocol followed for colostomy closure included the following-no bowel preparation or nasogastric tube, no overnight fasting, single dose of antibiotic prophylaxis, avoiding opioids, packing proximal stoma till mobilization and starting early oral feeds postoperatively. The continuous parameters were expressed as mean ± standard deviation or median (range) while the descriptive parameters were expressed as number and percentage. Results A total of 90 patients were included in the study. Most of the patients had colostomy for anorectal malformation. Five of them had significant luminal discrepancy of 4 or more times. Full feeds were reached within 2 days in 79 patients. Postoperative hospital stay was 2-3 days in 62 patients. Six patients stayed for more than 5 days, due to complications requiring further management. We noted surgical site infection in 6 patients all of whom were managed with regular wound dressings and fecal fistula in 4 cases, two of which resolved spontaneously. Conclusion ERAS protocol in colostomy closure reduces the hospital stay and is cost effective, with early recovery and no added complications.
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Affiliation(s)
- Vidya M. Saravagol
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anand Alladi
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - B. Mamatha
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Kanneganti P, Verma A, Mandelia A, Upadhyaya VD, Kumar B, Kumar T, Agarwal N, Kannojia A. Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study. J Indian Assoc Pediatr Surg 2024; 29:240-244. [PMID: 38912029 PMCID: PMC11192251 DOI: 10.4103/jiaps.jiaps_238_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. Materials and Methods This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. Results The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Conclusion Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.
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Affiliation(s)
- Pujana Kanneganti
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Anju Verma
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Ankur Mandelia
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Vijai Datta Upadhyaya
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Basant Kumar
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Tarun Kumar
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Nishant Agarwal
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Ashish Kannojia
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
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Cope J, Greer D, Soundappan SSV, Pasupati A, Adams S. The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study. J Pediatr Surg 2024; 59:701-708. [PMID: 38135546 DOI: 10.1016/j.jpedsurg.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/27/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Keeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure. METHODOLOGY A retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications. RESULTS Of the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications. CONCLUSION Commencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations. LEVEL OF EVIDENCE III.
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Affiliation(s)
- James Cope
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of NSW, Kensington, NSW, 2033, Australia
| | - Douglas Greer
- Toby Bowring Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Soundappan S V Soundappan
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, 2050, Australia
| | - Aneetha Pasupati
- Toby Bowring Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Susan Adams
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of NSW, Kensington, NSW, 2033, Australia; Toby Bowring Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.
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Hung TY, Bai GH, Tsai MC, Lin YC. Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Anesth Analg 2024; 138:108-122. [PMID: 36571797 DOI: 10.1213/ane.0000000000006341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Various regional analgesic techniques have been used in pediatric inguinal surgery to facilitate postoperative recovery. However, each technique's relative performance was undetermined owing to the lack of quantitative analysis. METHODS We systematically searched MEDLINE, Cochrane Library, EMBASE, and Web of Science for randomized controlled trials that compared regional analgesia in pediatric inguinal surgeries. After critical study screening and selection, a random-effects network meta-analysis was performed. The primary outcome was the time to the first rescue analgesic after surgery, and the secondary outcomes were the number of patients requiring rescue analgesics after surgery, postoperative pain scores, incidence of postoperative nausea and vomiting, and other adverse events. RESULTS This network meta-analysis included 69 randomized controlled trials (4636 patients) that compared 10 regional analgesic techniques. Our study revealed that the quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic after pediatric inguinal surgeries, by 7.7 hours (95% confidence interval [CI], 5.0-10.3) and 6.0 hours (95% CI, 3.9-8.2) when compared with the control group, respectively. In the subgroup involving only inguinal hernia repair, the quadratus lumborum block significantly prolonged the time to the first rescue analgesic than all other regional analgesics. In contrast, in the subgroup involving orchidopexies, only the caudal block significantly prolonged the time to the first rescue analgesic when compared with the control group (4.1 hours; 95% CI, 0.7-7.5). Wound infiltration and landmark-based ilioinguinal-iliohypogastric block had relatively poor analgesic effects than other regional analgesics. No serious adverse effects related to the regional analgesic techniques were reported in any of the included studies. CONCLUSIONS The quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic and the least rescue analgesic requirement for pediatric inguinal surgeries. Specifically, the quadratus lumborum block had the longest analgesic duration in inguinal hernia repair, and the caudal block was found to be the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. Most included randomized controlled trials had some concern or a high risk of bias, and future studies should focus on providing high-quality evidence to further clarify the analgesic effects of regional analgesia for pediatric inguinal surgeries.
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Affiliation(s)
- Tsung-Yu Hung
- From the Department of Anesthesia, MacKay Memorial Hospital, Taipei, Taiwan
| | - Geng-Hao Bai
- Department of General Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Chen Tsai
- Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ying-Chun Lin
- From the Department of Anesthesia, MacKay Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Cai Y, Cai X, Zhang X, Zhu J, Chen W. Impact of enhanced recovery after surgery protocols on surgical site wound infection rates in urological procedures. Int Wound J 2024; 21:e14582. [PMID: 38272818 PMCID: PMC10789582 DOI: 10.1111/iwj.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
This meta-analysis assesses the impact of Enhanced Recovery After Surgery (ERAS) protocols on surgical site wound infections (SSWIs) in urological procedures. Analysing data from 10 studies, our focus was on SSWI rates on the third and seventh postoperative days. The results reveal a significant reduction in SSWI rates for patients managed under ERAS protocols compared with traditional care. Notably, Figure 4 demonstrates a substantial decrease in SSWI on the third day (I2 = 93%; random: standardized mean difference [SMD]: -6.25, 95% confidence interval [CI]: -7.42 to -5.05, p < 0.01), and Figure 5 mirrors this trend on the seventh day (I2 = 95%; random: SMD: -4.72, 95% CI: -6.28 to -3.16, p < 0.01). These findings underscore the effectiveness of ERAS protocols in minimizing early postoperative wound infections, emphasizing their importance for broader implementation in urological surgeries.
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Affiliation(s)
- Yongjian Cai
- Department of UrologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Xianguo Cai
- Department of UrologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Xianjun Zhang
- Department of UrologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Jialiang Zhu
- Department of UrologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Wanbo Chen
- Department of UrologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
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Montalva L, Cheng LS, Kapur R, Langer JC, Berrebi D, Kyrklund K, Pakarinen M, de Blaauw I, Bonnard A, Gosain A. Hirschsprung disease. Nat Rev Dis Primers 2023; 9:54. [PMID: 37828049 DOI: 10.1038/s41572-023-00465-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Hirschsprung disease (HSCR) is a rare congenital intestinal disease that occurs in 1 in 5,000 live births. HSCR is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the intestine. Most patients present during the neonatal period with the first meconium passage delayed beyond 24 h, abdominal distension and vomiting. Syndromes associated with HSCR include trisomy 21, Mowat-Wilson syndrome, congenital central hypoventilation syndrome, Shah-Waardenburg syndrome and cartilage-hair hypoplasia. Multiple putative genes are involved in familial and isolated HSCR, of which the most common are the RET proto-oncogene and EDNRB. Diagnosis consists of visualization of a transition zone on contrast enema and confirmation via rectal biopsy. HSCR is typically managed by surgical removal of the aganglionic bowel and reconstruction of the intestinal tract by connecting the normally innervated bowel down to the anus while preserving normal sphincter function. Several procedures, namely Swenson, Soave and Duhamel procedures, can be undertaken and may include a laparoscopically assisted approach. Short-term and long-term comorbidities include persistent obstructive symptoms, enterocolitis and soiling. Continued research and innovation to better understand disease mechanisms holds promise for developing novel techniques for diagnosis and therapy, and improving outcomes in patients.
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Affiliation(s)
- Louise Montalva
- Department of Paediatric Surgery, Robert-Debré Children's University Hospital, Paris, France.
- Faculty of Health, Paris-Cité University, Paris, France.
- NeuroDiderot, INSERM UMR1141, Paris, France.
| | - Lily S Cheng
- Division of Paediatric Surgery, Texas Children's Hospital, Houston, TX, USA
- Division of Paediatric Surgery, University of Virginia, Charlottesville, VA, USA
| | - Raj Kapur
- Department of Pathology, Seattle Children's Hospital, Seattle, WA, USA
| | - Jacob C Langer
- Division of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominique Berrebi
- Department of Pathology, Robert-Debré and Necker Children's University Hospital, Paris, France
| | - Kristiina Kyrklund
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mikko Pakarinen
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ivo de Blaauw
- Department of Surgery, Division of Paediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, Netherlands
| | - Arnaud Bonnard
- Department of Paediatric Surgery, Robert-Debré Children's University Hospital, Paris, France
- Faculty of Health, Paris-Cité University, Paris, France
- NeuroDiderot, INSERM UMR1141, Paris, France
| | - Ankush Gosain
- Department of Paediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
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Gamble J, Rosen D. 2023 Canadian Pediatric Anesthesia Society Statement on fasting for elective pediatric anesthesia. Can J Anaesth 2023; 70:1295-1299. [PMID: 37344743 DOI: 10.1007/s12630-023-02509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Jonathan Gamble
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, Royal University Hospital, University of Saskatchewan, G525-103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - David Rosen
- Department of Anesthesiology and Pain Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Alassiri A, AlTayeb A, Alqahtani H, Alyahya L, AlKhashan R, Almutairi W, Alshawa M, Al-Nassar S, Habib Z, AlShanafey S. Implementation of Enhanced Recovery After Surgery protocols for gastrostomy tube insertion in patients younger than 14 years of age: a retrospective cohort study. Ann Saudi Med 2023; 43:227-235. [PMID: 37554026 DOI: 10.5144/0256-4947.2023.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have improved treatment outcomes and have standardized patient care. OBJECTIVES Identify the benefit of introducing the ERAS protocol for feeding after gastrostomy insertion with or without Nissen fundoplication, the effects on the time of reaching the full feeds the length of stay single-center experience, and complications associated with early feeding protocols. DESIGN Retrospective cohort study SETTING: Tertiary hospital METHODS: The study review included cases performed between 2015 and 2021 by four surgeons, and cases performed in 2022 by all surgeons using ERAS feeding protocol (P) in a tertiary hospital. MAIN OUTCOME MEASURES Comparison the mean and mode of the length of stay (LOS) and the time until the patient reached full feed (TFF). SAMPLE SIZE 224 patients; 181 by the four surgeons and 43 cases by the ERAS protocol group. RESULTS The difference in the ERAS protocol from the four surgeons in TFF and LOS was statistically significant (P<.001). There was no noticeable difference in postoperative complications after introducing the ERAS protocol. CONCLUSION ERAS improved the TFF and decreased the LOS without any increase in procedure complications. Increasing bed utilization and reducing costs were two benefits of reducing LOS at our hospital. LIMITATIONS Single-center study, which may not be generalizable. Multiple comorbidities. Travel time from different parts of the country could impact LOS. Retrospective and thus dependent on the accuracy of the information in file notes. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ali Alassiri
- From the Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Afaf AlTayeb
- From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hawazin Alqahtani
- From the Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Lama Alyahya
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raghad AlKhashan
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waad Almutairi
- From the Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alshawa
- From the Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saleh Al-Nassar
- From the Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zakaria Habib
- From the Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saud AlShanafey
- From the Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Hafeman M, Greenspan S, Rakhamimova E, Jin Z, Moore RP, Al Bizri E. Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis. Front Pediatr 2023; 11:1173700. [PMID: 37325354 PMCID: PMC10265625 DOI: 10.3389/fped.2023.1173700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background The caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques. Objective This review examined the duration of analgesia in pediatric patients (age 0-18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting. Evidence review We systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020-2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration. Findings Twelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70-2.81, p = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02-0.98, p = 0.04). No statistically significant differences were detected in other outcomes. Conclusion This meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876.
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Affiliation(s)
- Michael Hafeman
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States
| | - Seth Greenspan
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States
| | - Emiliya Rakhamimova
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States
| | - Robert P. Moore
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States
| | - Ehab Al Bizri
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States
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Martynov I, Scholz S, Perger L, Lacher M. Implementation of Enhanced Recovery Protocols After Minimally Invasive Surgery in Children: A Multinational Survey Study Among International Pediatric Endosurgery Group and European Paediatric Surgeons' Association Members. J Laparoendosc Adv Surg Tech A 2023; 33:503-511. [PMID: 37062759 DOI: 10.1089/lap.2022.0537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Aim: The aim of this multinational survey was to provide insights into individual surgeon's experience with implementation of enhanced recovery after surgery (ERAS) programs centered on minimally invasive surgery (misERAS) and to identify perceived barriers to utilization of these protocols. Methods: An online survey was conducted between July 2021 and March 2022 on behalf of the International Pediatric Endosurgery Group (IPEG) and European Paediatric Surgeons' Association (EUPSA) Research Committees. All IPEG and EUPSA members were contacted by e-mail and asked to complete an anonymous questionnaire that included 20 items. Results: Of an estimated 890 IPEG and 800 EUPSA members, 248 completed the survey (14.7%). A minority of respondents (n = 45, 18.1%) stated that misERAS protocols were followed as "utilizing specific ERAS guidelines," whereas 67.3% (n = 167) replied that they were trying to adhere to the basic ERAS principles in their practice. Almost half (n = 117, 47.2%) of the respondents stated that there was an increase in implementation of specific misERAS guidelines over the last 5 years. A lack of education and standardized protocols, lack of support and collaboration, and the existing culture leading to moderate to extreme barriers to misERAS implementation were reported by 25%-40% of respondents. Conclusions: This survey demonstrates that pediatric surgeons from the IPEG and EUPSA communities try to adhere to basic ERAS principles when performing MIS. The major barrier to misERAS implementation is profound lack of education. The fact that only 18% of respondents utilize specific institutional misERAS protocols suggests that at present, ERAS has not found its way into MIS in the broad landscape.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Stefan Scholz
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lena Perger
- Division of Pediatric Surgery, Department of General Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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Fung ACH, Chu FYT, Chan IHY, Wong KKY. Enhanced recovery after surgery in pediatric urology: Current evidence and future practice. J Pediatr Urol 2023; 19:98-106. [PMID: 35995660 DOI: 10.1016/j.jpurol.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/04/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To offer an up-to-date appraisal of the current status of enhanced recovery after surgery (ERAS) protocols in pediatric urology and to provide a guide for the clinical urologist. MATERIALS AND METHODS We performed a comprehensive literature search and scoping review on ERAS protocols in pediatric urology using Pubmed (from 1946), Cochrane library, and MEDLINE to December 2021 with the terms ''enhanced recovery'', ''protocolised care'', ''post-operative protocol", ''fast-track surgery'' and ''pediatric urology". Studies were excluded if they did not include perioperative intervention related to urological procedures, no full-text available and in non-English language. RESULTS To date, eight clinical studies (involving 1153 patients) have been published on ERAS protocols in pediatric urology. The patients involved ranged from neonates to adolescents, and the urological procedures included bladder augmentation, the Mitrofanoff procedure, laparoscopic pyeloplasty, laparoscopic nephrectomy, hypospadias repair, etc. Multidisciplinary components such as surgical and anesthetic considerations have been employed in ERAS protocols. The length of hospital stay was significantly lower in the ERAS groups with earlier enteral feeding resumption and return of bowel function in pediatric urology patients. The implementation of ERAS protocols does not result in higher complication and readmission rates; instead, some studies have even demonstrated a significant reduction in complication occurrence. CONCLUSION ERAS is novel to pediatric urology with a limited scale of published data in the literature. Initial clinical studies revealed that ERAS appears to be efficacious in the field of pediatric urology. Further prospective studies formulating a standardized multimodal protocol are encouraged to better understand key components of ERAS and incorporate ERAS into clinical practice to optimize surgical outcomes for pediatric urology procedures.
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Topçu SY, Semerci R, Kostak MA, Güray Ö, Sert S, Yavuz G. The effect of an interactive robot on children's post-operative anxiety, mobilization, and parents' satisfaction; randomized controlled study. J Pediatr Nurs 2023; 68:e50-e57. [PMID: 36437131 DOI: 10.1016/j.pedn.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of an interactive robot on Turkish children's post-operative anxiety, mobilization, and parents' satisfaction related to post-operative care. METHOD A randomized controlled study was conducted with 84 children who will undergo day surgery aged 5-10 years and their parents at a university hospital between June 2020-April 2022. The interactive robot was provided to accompany the children during the postoperative mobilization. Children in the control group received standard care during mobilization. Data were collected using the Personal Information Form, Children's State Anxiety (CSA), Parental Satisfaction Scale-Visual Analog Scale, and Mobilization Chart. RESULTS It was determined that the CSA score of the children in the control group were higher than the intervention group before their first mobilization after surgery (p = 0.005). During the first (p = 0.042) and second (p = 0.012) mobilization, it was determined that the mobilization duration of children in the intervention group was longer than the children in the control group. It was found that the parents of the children in the intervention group had a high level of satisfaction. CONCLUSION It has been determined that interactive robots positively affect postoperative mobilization in children undergoing day surgery, reduce the anxiety level of children before mobilization, and increase the duration of mobilization. In addition, the use of interactive robots increased parents' satisfaction with post-operative mobilization care. PRACTICE IMPLICATIONS Using interactive robots to reduce the stress and anxiety of children during the perioperative process can be a promising approach to improve their recovery by providing early mobilization.
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Affiliation(s)
- Sacide Yildizeli Topçu
- Trakya University, Faculty of Health Science, Department of Surgical Nursing, Edirne, Turkey.
| | | | - Melahat Akgün Kostak
- Trakya University, Faculty of Health Science, Department of Pediatric Nursing, Edirne, Turkey
| | - Özlem Güray
- Trakya University Hospital, Department of Pediatric Surgical, Edirne, Turkey
| | - Senem Sert
- Trakya University Hospital, Department of Pediatric Surgical, Edirne, Turkey
| | - Gözde Yavuz
- Trakya University Hospital, Department of Pediatric Surgical, Edirne, Turkey
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Liu K, Lv M, Liu X, Wang H, Chen Z, Xu H. Knowledge, attitudes and practices of enhanced recovery after surgery among paediatric surgical nurses in China: A Cross-Sectional study. Nurs Open 2022; 10:1830-1839. [PMID: 36314846 PMCID: PMC9912383 DOI: 10.1002/nop2.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 05/04/2022] [Accepted: 10/12/2022] [Indexed: 02/11/2023] Open
Abstract
AIM To investigate paediatric surgical nurses' knowledge, attitudes and practices (KAP) regarding enhanced recovery after surgery (ERAS). DESIGN A cross-sectional study. METHODS A 34-question survey was developed. An electronic version of the questionnaire was distributed to nurses working in paediatric surgical departments of 22 tertiary hospitals from 14 provinces of China by means of convenience sampling from February to April 2021. A total of 855 nurses' data was used as the final sample. The statistical analysis included nonparametric test, Spearman's correlation and multiple linear regression. RESULTS There is still room for improvement regarding the KAP of paediatric surgical nurses, especially in the knowledge of "postoperative recovery" and "preoperative preparation". The influencing factors of KAP were educational level, geographical region (South, Central, North, Northwest), years of work experience, hospital category (general hospital, women and children's hospital), and familiarity with ERAS.
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Affiliation(s)
- Ke‐Xian Liu
- Nursing DepartmentChildren′s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, ChinaHangzhouChina
| | - Meng Lv
- Nursing DepartmentChildren′s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, ChinaHangzhouChina
| | - Xiao‐Shu Liu
- Nursing DepartmentChildren′s Hospital of Jiangxi ProvinceNanchangChina
| | - Hong‐Qin Wang
- Nursing DepartmentChildren′s Hospital of Anhui ProvinceHefeiChina
| | - Zhi‐Min Chen
- Respiratory DepartmentChildren′s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, ChinaHangzhouChina
| | - Hong‐Zhen Xu
- Nursing DepartmentChildren′s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, ChinaHangzhouChina
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Implementation and outcomes of enhanced recovery protocols in pediatric surgery: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38:157-168. [PMID: 34524519 DOI: 10.1007/s00383-021-05008-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This systematic review examines the feasibility and safety of implementing Enhanced recovery after Surgery (ERAS) protocols in children. STUDY DESIGN A systematic search of Medline, PubMed, and the Cochrane library for papers describing ERAS implementation in children between January 2000 and January 2021. The systematic review was performed according to the PRISMA statement. The meta-analysis was done using R Software (Ver 4.0.2). p value of < 0.05 was considered statistically significant. RESULTS Sixteen studies, describing a total of 1723 patients, were included in the meta-analysis. An average of 15 (range 11-16) relevant components were implemented with an overall compliance close to 84%. The time to initiate feeds and reach full enteral nutrition was reduced in ERAS group with mean difference (MD) of - 21.20 h (95% CI - 22.80, - 19.59, p < 0.01), and - 2.20 days (95% CI - 2.72, - 1.71, p < 0.01), respectively. The use of opioids for postoperative analgesia was reduced with MD of -0.86 morphine equivalents mg/kg (95% CI - 1.40, - 0.32, p < 0.01). The length of hospital stay showed a significant reduction with MD of -2.54 days (95% CI - 2.94, - 2.13, p < 0.01). There was no difference in the complication and readmission rates between the groups. CONCLUSION ERP implementation in pediatric perioperative care is a viable option in a variety of surgical settings. There is clear evidence of a decrease in hospital stay duration with no increase in complication or readmission rates. The length of hospital stay reduced in inverse proportion to the number of ERAS elements implemented. Parental satisfaction is increased by initiating enteral feeding early, minimizing catheter and drain use, and reducing opioid use.
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