Effect Of Enhanced Recovery After Surgery On Robotic Assisted Laparoscopic Pyeloplasty

Background :Enhanced recovery after surgery(ERAS)refers to the use of a series of perioperative optimization measures with evidence-based medical evidence to reduce or relieve the psychological and physical trauma stress of patients and promote the rapid recovery of patients after surgery.A large number of studies at domestic and abroad have confirmed that ERAS can be safely and effectively used in adult patients.Compared with adult patients,pediatric patients tend to face greater stress reaction during the perioperative period,which affects their prognosis.Some studies have shown that some measures in ERAS play a positive role in accelerating the rehabilitation of children during perioperative period.Leonardo da Vinci robot-assisted endoscopic surgery system has been successfully applied to pediatric surgery in the past 20 years,but it takes a long time to prepare the gastrointestinal tract before operation.taking Trenderberg(Trendelenburg)position and CO2 pneumoperitoneum for a long time may increase perioperative pneumoperitoneum-related complications and the risk of hypothermia,pressure injury,scald and so on.Therefore,it is necessary to explore its effective perioperative management measures.The purpose of this study was to evaluate the safety and efficacy of ERAS in children undergoing robot-assisted laparoscopic pyeloplasty.Objective :To evaluate the safety and efficacy of ERAS in robotic assisted laparoscopic pyeloplasty.Methods :Sixty children with hydronephrosis who underwent robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019 were selected,aged from 3 to 12 years old,regardless of sex,ASA grade Ⅰ or Ⅱ.No previous abdominal surgery;no perforation,obstruction,severe infection,moderate and severe dehydration,toxic shock,high abdominal distension,severe malnutrition and high fever;no nervous system and immune system diseases,no malignant tumor,no abnormal function of heart,liver and kidney;no contraindications such as anesthesia and pneumoperitoneum.The rats were randomly divided into two groups: control group(n = 28)and ERAS group(n = 32).ERAS group was given ERAS education before operation,shortened the time of fasting and water,drank glucose water 2 hours before operation,optimized anesthesia scheme,received protective lung ventilation and target-directed fluid therapy,took heat preservation and multi-mode antiemetic measures during operation,and took multi-mode analgesia measures after operation,including early oral feeding and water intake,and getting out of bed as soon as possible.The control group adopted the traditional concept for perioperative management.The changes of vital signs and cardiovascular adverse events were recorded before anesthesia(T0),immediately after endotracheal intubation(T1),30 min,1 and 2hours after the establishment of pneumoperitoneum(T2mur4),5min after pneumoperitoneum(T5)and 5min after extubation(T6).The change trend of respiratory parameters,including peak airway pressure(Peak Inspiratory Pressure,PIP)and tidal volume(Tidalvolume,VT),was recorded.Blood gas analysis was performed at(T1mur4),and the related values were recorded.The postoperative hospital stay,the time of extubation of endotracheal tube,the first time of drinking and eating,the time of first going to the ground,the time of first exhaust,the time of pulling out catheter and drainage tube were recorded.The total postoperative complications were evaluated by Clavin-Dindo grade,including nausea and vomiting,abdominal distension,abdominal pain,incision infection,abdominal infection and anastomotic leakage.The restlessness during the recovery period was evaluated by the restlessness scale of recovery period(Pediatric Anesthesia Emergency Delirium,PAED).The modified facial expression pain scale(Faces Pain Scale-Revised,FPS-R)was used to evaluate the degree of pain within 72 hours after operation.Results:1.Compared with the control group,there was no increase in the incidence of cardiovascular adverse events and perioperative complications in ERAS group.(P > 0.05).2.Compared with the control group,the Lactate(Lac)of arterial blood lactate and PIP in ERAS group decreased,and the change of heart rate was more stable.(p < 0.05).3.Compared with the control group,the postoperative hospital stay in ERAS group was shorter,and the postoperative recovery was better(postoperative first ground movement time,postoperative intestinal exhaust time,postoperative restlessness score and pain score)(p < 0.05).Conclusion:ERAS can be safely and effectively used in children undergoing robot-assisted laparoscopic pyeloplasty.