Multimodal Perioperative Management For Pediatric Anesthesia On Postoperative Cognitive Behavior

Objective: In recent years,the application of the Enhanced Recovery After Surgery concept has been gradually extended to a number of areas,and it achieved good results.Anesthesia is not limited to the protection of patients during surgery and provide good surgical conditions,which runs through the entire perioperative stages which contain preoperative preparation 、 intraoperative and postoperative rehabilitation.It plays a decisive effect in the implementation of Enhanced Recovery After Surgery.This study take multi-factor intervention in order to explore whether multimodal perioperative management can help children who have performed surgery reduce the occurrence of emergence agitation and negative postoperative behavioural changes.Methods: A total of 200 children undergone abdominal surgery,aged 1-6 year old,with level ⅠorⅡof ASA,were randomly divided into multimodal perioperative treatment group(group M)or routine perioperative treatment group(group C).The children in group M were given psychological guidance on preoperative day and given 5% glucose,5 ml/kg,2 h before the surgery,intravenous injecting midazolam0.02 mg/kg before entering the operating room,then administer total intravenous anesthesia.Local infiltrate the operative wound with 0.25% ropivacaine at the end of the surgery.Children in group M are taken care of in the post-anesthesia careunit(PACU),and injected with a small amount of liquid after they recovery consciousness.The children in group C were treated with routine anesthesia operation.Modified Children′s Hospital of Eastern Ontario Pain Scale(m-CHEOPS),pediatric anesthesia emergence delirium(PAED)score and incidences of EA at 5 min,15 min after extubation,incidences of NPOBCs at one day,one week,one month after operation were recorded and compared.Results: Compared with group C,PAED score and incidence rates of EA at 5 min,15 min after extubation,m-CHEOPS score,incidence rates of NPOBCs at one day after operation decreased in group D(P<0.05 or 0.01).The incidence rates of NPOBCs at one week and one month in two groups have no statistical difference.Conclusion: Multimodal perioperative treatment has a preventive effect on emergence agitation in children with general anesthesia,and can reduce the incidence of negative postoperative behavioural changes in one day after operation.