Effects Of Different Anesthesia Maintenance On Postoperative Short-term Cognitive Function Of Children Undergoing Robot-assisted Pyeloplasty With ERAS Pattern

Objective:To observe the effects of different anesthesia maintenance methods on cognitive function and the expression of related markers shortly after robotic-assisted laparoscopic pyeloplasty in children with ERAS.Methods:A total of 68 children with hydronephrosis aged 3 to 12 years old who were scheduled to robotic-assisted laparoscopic pyeloplasty from December 2020 to November 2021.All of them met the diagnostic criteria of hydronephrosis and had no medical treatment,completed previous examinations and didn’t have obvious abnormality,graded ASA I or II.Any patients with previous abdominal surgery,mental system disorders,immune system diseases,wasting disease,chronic inflammation,malignant tumor,congenital heart disease,or intellectual developmental disorder was excluded.68 children were randomly divided into intravenous anesthesia maintenance group（PR group,n=34）and inhalation anesthesia maintenance group（SF group,n=34）.All patients were under ERAS protocols and induced with 0.1mg/kg midazolam,2～3 mg/kg propofol and 3?g/kg fentanyl,0.6 mg/kg rocuronium,then maintained with 5～12 mg?kg^-1?h^-1 propofol and 0.2～0.5?g?kg^-1?min^-1 remifentanil（PR group）or 2%to 3%sevoflurane and 1?g/kg fentanyl（SF group）,adjusted on the basis of vital signs and BIS values.Emergence agitation was evaluated by the pediatric anesthesia emergency delirium（PAED）scale immediately（T₈）,10 minutes（T₉）,20 minutes(T₁₀)after extubation,and 1^stday（D₁）after surgery,the total score was 20 points,and scored more than 12 was defined as agitation.Serum interleukin-6（IL-6）,S-100βand neuron specificity enolase（NSE）were measured by ELISA before surgery（S₀）,immediately（S₁）,1^st day（S₂）,3^rd day（S₃）,and 7^thday（S₄）after surgery（the serum was centrifugated at 4℃,2500 x g for 20 min,and the above solution was stored at-20°C until use）.Pain assessment make use of the facial visual analog scale（F-VAS）one hour（D₀）,1^st day（D₁）,3^rd day（D₃）,and 7^th day（D₇）after operation,and postoperative nausea and vomit was recorded on D₀,D₁,D₃,and D₇.Vital signs,adverse events,and temperature were recorded at the time from the children entering the operating room（T₀）,instantly after orotracheal intubation（T₁）,before incision（T₂）,5 minutes（T₃）,one hour（T₄）,two hours（T₅）after pneumoperitoneum,and immediately after pneumoperitoneum（T₆）,operation（T₇）and T₈.Respiratory parameter at T₁～₇ and the blood gas analysis values at T₁,T₄～₆ were recorded.Record the time from drug withdrawal to extubation,the children’s eye-opening time after extubation,reaction time（can communicable verbally）.We also observe the recovery after operation,including the first anus exhaust time,first drinking time,first time eating liquid food,first time getting out of bed,removal time of catheter,and removal time of drainage tube and the postoperative hospital stays.Results:1.The incidence of emergence delirium in the PR group was significantly lower than that in the SF group（11.8%vs 32.4%）（P<0.05）.2.As compared with pre-operative values,the levels of IL-6,S-100β,and NSE in both groups increased significantly at multiple time points post-operative（all P<0.05）.The IL-6and S-100βexpression of serum were significantly differences between the PR group and the SF group at multiple time points post-operative（P<0.05）.The serum IL-6 levels were lower in the PR group compared with the SF group at the end of operation immediately（P<0.05）.Serum levels of S-100βin the PR group at 1^st and 3^rdday after surgery was significantly reduced than those in the SF group（all P<0.05）.3.The pain degree at one hour postoperatively in the PR group was meaningfully lower than that in the SF group（P<0.05）.4.Mean arterial pressure（MAP）at T₈,heart rate（HR）at T₂～₆ and lactic acid value at T₄～₆ fluctuated less during the perioperative period in PR group than in SF group（all P<0.05）.5.The postoperative extubation time,eye opening time and response time of children in the PR group were significantly longer than those of children in the SF group（all P<0.05）.Conclusion:Compared with inhalational anesthetics maintenance,intravenous anesthetics maintenance could mitigate postoperative short-time cognitive impairment of children undergoing robot-assisted pyeloplasty surgery with ERAS pattern,and the perioperative hemodynamic variables were more stable.