Enhancing recovery after minimally invasive surgery in children: A systematic review of the literature and meta-analysis

Dagorno, Claire; Montalva, Louise; Ali, Liza; Brustia, Raffaele; Paye-Jaquen, Annabel; Pio, Luca; Bonnard, Arnaud

doi:10.1016/j.jpedsurg.2021.04.004

Cited by 17 publications

(21 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are consistent with other ERP studies. [47][48][49] There was no measurable difference in postoperative maximum pain scores or opioid use.…”

Section: Laparoscopic Appendectomymentioning

confidence: 90%

See 1 more Smart Citation

Outcomes for 41 260 pediatric surgical patients with opioid‐free anesthesia: One center's experience

Martin

Franz

Rampersad

et al. 2023

Pediatric Anesthesia

View full text Add to dashboard Cite

Background Opioid use is common and associated with side effects and risks. Consequently, analgesic strategies to reduce opioid utilization have been developed. Regional anesthesia and multimodal strategies are central tenets of enhanced recovery pathways and facilitate reduced perioperative opioid use. Opioid‐free anesthesia (OFA) protocols eliminate all intraoperative opioids, reserving opioids for postoperative rescue treatment. Systematic reviews show variable results for OFA. Methods In a series of Quality Improvement (QI) projects, multidisciplinary teams developed interventions to test and spread OFA first in our ambulatory surgery center (ASC) and then in our hospital. Outcome measures were tracked using statistical process control charts to increase the adoption of OFA. Results Between January 1, 2016, and September 30, 2022, 19 872 of 28 574 ASC patients received OFA, increasing from 30% to 98%. Post Anesthesia Care Unit (PACU) maximum pain score, opioid‐rescue rate, and postoperative nausea and vomiting (PONV) treatment all decreased concomitantly. The use of OFA now represents our ambulatory standard practice. Over the same timeframe, the spread of this practice to our hospital led to 21 388 of 64 859 patients undergoing select procedures with OFA, increasing from 15% to 60%. Opioid rescue rate and PONV treatment in PACU decreased while hospital maximum pain scores and length of stay were stable. Two procedural examples with OFA benefits were identified. The use of OFA allowed relaxation of adenotonsillectomy admission criteria, resulting in 52 hospital patient days saved. Transition to OFA for laparoscopic appendectomy occurred concomitantly with a decrease in the mean hospital length of stay from 2.9 to 1.4 days, representing a savings of >500 hospital patient days/year. Conclusions These QI projects demonstrated that most pediatric ambulatory and select inpatient surgeries are amenable to OFA techniques which may reduce PONV without worsening pain.

show abstract

“…These findings are consistent with other ERP studies. [47][48][49] There was no measurable difference in postoperative maximum pain scores or opioid use.…”

Section: Laparoscopic Appendectomymentioning

confidence: 90%

“…17 stay should be used to modify opioid prescription practices. [46][47][48] This recommendation was used by our surgeons to nearly eliminate routine postoperative opioid prescription for laparoscopic appendectomy patients, except when requiring opioids prior to discharge.…”

Section: Ta B L Ementioning

confidence: 99%

Outcomes for 41 260 pediatric surgical patients with opioid‐free anesthesia: One center's experience

Martin

Franz

Rampersad

et al. 2023

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…In recent years, minimally invasive surgery in pediatric patients is the standard of care for many surgical procedures. The benefits of minimally invasive surgery compared to open surgery are well known and were reported many times, including faster recovery, minor pain, fewer complication rates, better cosmetic effects, shorter length of hospital stay, and, finally, lower costs [ 1 ]. The most common elective surgical procedures in pediatric patients to which laparoscopy can be applied include procedures of the inguinoscrotal region, such as inguinal hernia repair, orchiopexy for abdominal testis, varicocelectomy, etc.…”

Section: Introductionmentioning

confidence: 99%

“…The airway should be secured using an endotracheal tube or a laryngeal mask airway depending on surgical procedure and age of the patient. Inhalational anesthetics with mixtures of air and oxygen can be used for the maintenance of anesthesia, but total intravenous anesthesia is preferred by most of the pediatric anesthesiologists [ 1 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures

2021

View full text Add to dashboard Cite

Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. Methods: Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. Results: Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p < 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p < 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p < 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p < 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p < 0.00001) consumption per body weight were significantly lower in the ketofol group. Conclusions: TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery.

show abstract

“…13 Although limited, similar findings are emerging in the pediatric population. [14][15][16][17] Notably, there appears to be a lack of reduction in complication rates, perhaps due to the healthier pediatric population. To address unique aspects of the pediatric population, efforts have been focused on defining appropriate ERAS elements.…”

mentioning

confidence: 99%

Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Martin

Chiem

Hansen

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: Enhanced Recovery After Surgery (ERAS) was first established in 2001 focusing on recovery from complex surgical procedures in adults and recently expanded to ambulatory surgery. The evidence for ERAS in children is limited. In 2018, recognized experts began developing needed pediatric evidence. Center-wide efforts involving all ambulatory surgical patients and procedures have not previously been described. METHODS: A comprehensive assessment and gap analysis of ERAS elements in our ambulatory center identified 11 of 19 existing elements. The leadership committed to implementing an Enhanced Recovery Program (ERP) to improve existing elements and close as many remaining gaps as possible. A quality improvement (QI) team was launched to improve 5 existing ERP elements and to introduce 6 new elements (target 17/19 ERP elements). The project plan was broken into 1 preparation phase to collect baseline data and 3 implementation phases to enhance existing and implement new elements. Statistical process control methodology was used. Team countermeasures were based on available evidence. A consensus process was used to resolve disagreement. Monthly meetings were held to share real-time data, gather new feedback, and modify countermeasure plans as needed. The primary outcome measure selected was mean postanesthesia care unit (PACU) length of stay (LOS). Secondary outcomes measures were mean maximum pain score in PACU and patient/family satisfaction scores. RESULTS: The team had expanded the pool of active ERP elements from 11 to 16 of 19. The mean PACU LOS demonstrated significant reduction (early in phase 1 and again in phase 3). No change was seen for the mean maximum pain score in PACU or surgical complication rates. Patient/family satisfaction scores were high and sustained throughout the period of study (91.1% ± 5.7%). Patient/family and provider engagement/compliance were high. CONCLUSIONS: This QI project demonstrated the feasibility of pediatric ERP in an ambulatory surgical setting. Furthermore, a center-wide approach was shown to be possible. Additional studies are needed to determine the relevance of this project to other institutions.

show abstract

Enhancing recovery after minimally invasive surgery in children: A systematic review of the literature and meta-analysis

Cited by 17 publications

References 29 publications

Outcomes for 41 260 pediatric surgical patients with opioid‐free anesthesia: One center's experience

Outcomes for 41 260 pediatric surgical patients with opioid‐free anesthesia: One center's experience

Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures

Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Contact Info

Product

Resources

About