The Application Of Multimodal Perioperative Anesthesia Treatment On Enhanced Recovery After Surgery In Pediatric Surgery

Objective: Enhanced Recovery After Surgery(EARS)is the use of having a series of perioperative management optimization measures and effective and feasible strategy of evidence based on medicine to reduce stress and complications and speed up the patients’ recovery.ERAS requires teamwork and assistance to reach an optimal outcome,because it is the product of multi-disciplinary collaboration,and its contents include the entire perioperative period.In current clinical practice,it has been successfully applied in general surgery,such as orthopedic,urological,gynecological,cardiovascular and thoracic surgery many other clinical departments.It can obviously shorten the length of hospital stay,reduce complications and decrease the rehospitalization rate,without affecting the safety of patients,and also has a certain protective and promotive effect on organ function.To investigate the application of multimodal perioperative anesthesia on enhanced recovery after surgery in pediatric surgery by the means of preoperative education for children with perioperative psychological intervention,reasonable fasting scheme,appropriate medication before anesthesia,optimization of anesthesia,early postoperative feeding and other measures,and explore its feasibility and superiority.Methods: A total of 127 pediatric patients,scheduled for laparoscopic inguinal surgery,aged 1 to 3 years old,ASA I,were randomly assigned to two groups: control group(group C,n = 59)and multimodal group(group M,n = 68).Group C received routine preoperative interview and traditional anesthesia treatment.Group M received preoperative education,meticulous interview,preoperative fasting 4-6h,5% GS 5 ml/kg at preoperative 2 h,compound lidocaine cream with a thickness of 2mm covering the skin at the center of the surgical incision at preoperative 1h,intravenous injection of midazolam 0.02 mg/kg at preoperative 30 min,local infiltration of the incision with 0.25% ropivacaine 2 ml when suturing,comfort in the PACU and early feeding according to the recovery of the children after surgery.The sedation score of children apart from their parents,the receipt score of face mask for inhalation induction,total amount of anaesthetics,postoperative recovery(laryngeal mask time,consciousness recovery time,anesthesia recovery observation time),the pain score,Ramsay score,emergence agitation(EA)score,the degrees of parental satisfaction and postoperative adverse effects caused by anesthesia were recorded.Results: There were no significant differences in age,weight,sex,mode of birth,education level,family environment,parental education level,operation type,operation time and anesthesia time between group C and group M(P>0.05).Compared with group C,the sedation score of children apart from their parents and the receipt score of face mask for inhalation induction of group M were significantly increased(P <0.05).The total amount of propofol and remifentanil of group M were less than that of group C(P<0.05 or 0.01).Laryngeal mask time,consciousness recovery time and anesthesia recovery observation time of group M were shorter than that of group C(P<0.05 or 0.01).Compared with group C,Ramsay score of group M was significantly increased(P <0.01),the pain score and emergence agitation score of group M were decreased(P<0.05 or 0.01).The degrees of parental satisfaction of group M were higher than that of group C(P<0.05).There was no significant difference in the postoperative adverse effects(P>0.05).Conclusion: The application of multimodal perioperative anesthesia on enhanced recovery after surgery in pediatric surgery is effective,safe and feasible.It can not only reduce the traumatic stress response in children,reduce the dosage of general anesthesia medicine,but also can accelerate the recovery of children after surgery,and improve the satisfaction of children and parents,which help children and their parents obtain the maximum benefit.