THE INFLUENCE OF COMPLEX IMPLEMENTATION OF THE ERAS PROGRAM ON THE SURGICAL STRESS RESPONSE FACTORS IN PEDIATRIC PATIENTS UNDERGOING ELECTIVE LIMB SURGERY

Surgical stress response, fluid and nutritional balance, and pain management are among the key factors influencing on the postoperative period. These areas are reflected in the Enhanced Recovery After Surgery (ERAS) concept, which is based on a set of measures aimed at minimizing the surgical stress response. The lack of ERAS recommendations for the pediatric population of surgical patients prompts to search for a solution of adaptation and implementation of the ERAS programs in children. The aim of the study. To determine the effectiveness of the complex application of the enhanced recovery after surgery by studying its influence on the factors of the surgical stress response in pediatric patients undergoing limp surgery. Materials and methods. The prospective randomized study included 47 patients aged 1 to 17 years. In the study group (n = 22), the ERAS program was used, which consisted of 14 components of preoperative, intraoperative and postoperative measures. In the control group (n = 25), the complex of all ERAS components was not purposefully applied. We compared glycaemic stress index (GSI) and length of hospital stay after surgery (LOS) as a primary outcome; secondary outcomes were fasting time after drinking fluids before induction of anesthesia, estimated fluid deficiency just before induction of anesthesia, hemodynamic parameters, the need for opioids during and after surgery, blood glucose and beta-hydroxybutyrate in the beginning and in the end of the surgery and next day morning after surgery, postoperative nausea and vomiting. Results. GSI was significantly less in the study group (1,62 ± 0,78 vs 2,12 ± 0,93, р=0,046). LOS in the study group was 37.5% less than in the control group (p = 0.002). The period of preoperative fasting and fluid deficit in the patients of the study group were shorter. The needs of fentanyl intraoperatively in the study group was 47% less (p<0.001). At the beginning of surgery, the study group had a higher blood glucose concentration and a higher systolic blood pressure. At the end of surgery, blood glucose and beta-hydroxybutyrate in the study group was lower than in the control group. In the postoperative period, 9% of patients in the study group and 36% of patients in the control group complained of nausea (p = 0.041). Linear regression analysis showed a linear relationship between the LOS after surgery and the GSI (R=0,515, R2=0,266, B=2,156, 95% CI 1,04 – 3,27, p<0,001). Results. The implementation of the ERAS program to children 1-17 years old undergoing elective limp surgery may reduce the effect of the surgical stress reaction by reducing the period of preoperative fasting, fluid deficiency, the needs of opioids and postoperative nausea. Minimizing the surgical stress response may facilitate the achievement of hospital discharge criteria and shorten the length of hospital stay in the postoperative period.

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STRESS-LIMITING ANESTHESIA IN OPHTHALMOSURGERY

World Science ◽

10.31435/rsglobal_ws/30032021/7511 ◽

2021 ◽

Author(s):

Mynka N. V. ◽

Kobelyatskyy Yu. Yu.

Keyword(s):

Blood Glucose ◽

Stress Response ◽

General Anesthesia ◽

Surgical Stress ◽

Pain Syndrome ◽

Control Group ◽

Surgical Trauma ◽

Complete Protection ◽

Surgical Stress Response ◽

Anesthesia Group

Despite the significant advances made by modern anesthesiology in the perioperative management of patients, surgical interventions are still accompanied by a high proportion of complications and even deaths. At the same time, it is known that in 50% of cases mortality and serious postoperative complications could be prevented. After performing a thorough study of the factors affecting the increase in hospitalization and postoperative recovery (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), it was determined that the surgical stress response is the most significant inducer of dysfunction of various organs. and systems. To date, it has been established that general anesthesia in its classical sense does not allow achieving complete protection of the patient from surgical trauma. More complete protection can be achieved by combining general anesthesia with regional blockages and adjuvant drugs with stress-protective properties. In the present study, we compared the severity of the surgical stress response and pain syndrome in patients operated on under conditions of multicomponent balanced general anesthesia (group K) with patients who received a stress-limiting anesthesia regimen (group DB). In both groups, multicomponent anesthesia was performed, in group K, sibazone was used for sedation, in group DB, dexmedetomidine was used. Also, patients of the DB group underwent regional blockade (blockade of the pterygo-palatine fossa) before surgery. The main criteria for evaluating the results were: hemodynamic stability, blood glucose, the level of venous blood leukocytes and the severity of pain according to the VAS in the postoperative period. Both schemes made it possible to avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. When analyzing blood glucose and leukocyte counts, it was found that patients in the control group had a more significant deviation of both indicators from the preoperative level than in the stress-limiting anesthesia group. In the study of pain syndrome, it was determined that in the control group the level of pain according to the VAS was higher at all stages of the study compared to patients in the group of stress-limiting anesthesia.

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Surgical Stress Response and Enhanced Recovery after Laparoscopic Surgery - A systematic review

Chirurgia ◽

10.21614/chirurgia.113.4.455 ◽

2018 ◽

Vol 113 (4) ◽

pp. 455 ◽

Cited By ~ 6

Author(s):

Jacopo Crippa ◽

Gulio M. Mari ◽

Angelo Miranda ◽

Andrea T.M. Costanzi ◽

Dario Maggioni

Keyword(s):

Systematic Review ◽

Laparoscopic Surgery ◽

Stress Response ◽

Enhanced Recovery ◽

Surgical Stress ◽

Surgical Stress Response

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ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1424 ◽

2019 ◽

Vol 32 (1) ◽

Cited By ~ 3

Author(s):

Uirá Fernandes TEIXEIRA ◽

Marcos Bertozzi GOLDONI ◽

Fábio Luiz WAECHTER ◽

José Artur SAMPAIO ◽

Florentino Fernandes MENDES ◽

...

Keyword(s):

Enhanced Recovery ◽

Surgical Stress ◽

Length Of Hospital Stay ◽

Early Mobilization ◽

Oral Feeding ◽

Control Group ◽

Colonic Surgery ◽

Early Oral Feeding ◽

Tertiary Center ◽

Eras Protocol

ABSTRACT Background: After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. Aim: To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Results: There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.

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Preoperative regional scalp block versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3802 ◽

2020 ◽

Vol 11 (4) ◽

Author(s):

Ahmed Beniamen Mohamed Hussien ◽

ZakiTahaSaleh ◽

Hala Abdel Sadek Al attar ◽

Yasser Mohamed Nasr

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Response ◽

General Anaesthesia ◽

Surgical Stress ◽

Control Group ◽

Surgical Stress Response ◽

Intravenous Fentanyl ◽

Supratentorial Craniotomy ◽

Scalp Block

During brain tumour resection a lot of noxious stimuli are released resulting in a significant hemodynamic and stress response, its control is challenging during anaesthesia, and can be evaluated by monitoring blood pressure (BP), heart rate (HR) Attenuating autonomic cardiovascular responses to pain resulting from skull pinning, skin incision, and craniotomy are considered significant benefits of Regional Scalp Block (RSB) in addition to reducing postoperative analgesic requirements. This study aims to evaluate the effect of preoperative regional scalp block (RSB) versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia. The study included 30 patients randomly distributed into two equal groups with 15 patients in each, Group A: Preoperative RSB was done after induction of general anaesthesia and before skull pinning, Group C: Control group: patients were given conventional intraoperative analgesia in the form of intravenous fentanyl with no block. This study included patients with Supratentorial brain tumours were admitted to Zagazig University Hospitals. Patients have been gathered over two years duration from march 2018 to march 2020. The results showed that there were highly significant differences between RSB group and control group. Preoperative RSB showed advantages over Standard analgesia in terms of better attenuation of stress response to pain in the form of heart rate and blood pressure intraoperatively, decrease opioid consumption, lower Visual Analogue Score (VAS), Preoperative RSB can be performed easily in a short time with very high success rate allowing better intraoperative control of haemodynamics, less postoperative pain. We recommend using preoperative RSB in supratentorial craniotomy as a gold standard in our hospital to get the advantages mentioned above.

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Decreasing the Surgical Stress Response and an Initial Experience from the Enhanced Recovery After Surgery Colorectal Surgery Program at an Academic Institution

International Anesthesiology Clinics ◽

10.1097/aia.0000000000000162 ◽

2017 ◽

Vol 55 (4) ◽

pp. 163-178 ◽

Cited By ~ 4

Author(s):

Anathea C. Powell ◽

Matthias Stopfkuchen-Evans ◽

Richard D. Urman ◽

Ronald Bleday

Keyword(s):

Stress Response ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Surgical Stress ◽

Academic Institution ◽

Initial Experience ◽

Surgical Stress Response

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ERAS Improves Postoperative Recovery in Children

10.21203/rs.3.rs-736991/v1 ◽

2021 ◽

Author(s):

Tingmei Wu ◽

Haiwen Li ◽

Huixia Zhou ◽

Xuemei Hao ◽

Xiaojun Wang ◽

...

Keyword(s):

Inflammatory Cytokine ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Final Analysis ◽

Postoperative Recovery ◽

Controlled Study ◽

Control Group ◽

Robot Assisted ◽

Cytokine Levels ◽

Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

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