Enhanced Recovery After Surgery (ERAS) protocols have been increasingly implemented in pediatric surgery to optimize perioperative care, improve outcomes, and enhance the overall experience for pediatric patients and their families. While ERAS protocols have traditionally been more prevalent in adult surgery, their application in pediatric surgery is gaining recognition and adoption. Here’s how ERAS principles are being adapted for pediatric patients:
Preoperative Optimization:Preoperative optimization focuses on preparing pediatric patients for surgery to minimize the risk of complications and accelerate recovery. This may include preoperative nutritional optimization, hydration management, bowel preparation, and smoking cessation counseling (for parents in cases of passive smoke exposure).
Multimodal Pain Management: Effective pain management is essential for pediatric patients undergoing surgery to minimize discomfort and facilitate early mobilization and recovery. Multimodal pain management approaches, including regional anesthesia techniques (such as epidural or peripheral nerve blocks), non-opioid analgesics, and patient-controlled analgesia, are utilized to reduce the need for opioids and mitigate opioid-related side effects.
Early Oral Intake: Encouraging early oral intake of clear fluids and light meals postoperatively helps promote gastrointestinal function and reduce the risk of postoperative ileus. Clear guidelines regarding fasting periods before and after surgery are established to minimize unnecessary fasting and dehydration.
Early Mobilization: Early mobilization and ambulation are encouraged in pediatric patients following surgery to prevent complications such as muscle weakness, venous thromboembolism, and respiratory complications. Physical therapy and rehabilitation services may be provided to facilitate mobility and optimize functional recovery.
Optimized Fluid Management: Fluid management strategies aim to maintain euvolemia and prevent fluid overload or dehydration in pediatric patients undergoing surgery. Individualized fluid management protocols are developed based on patient factors such as age, weight, comorbidities, and surgical requirements.
Nausea and Vomiting Prophylaxis: Prophylaxis against postoperative nausea and vomiting (PONV) is essential for pediatric patients to minimize discomfort and prevent complications such as dehydration and aspiration. Antiemetic medications and non-pharmacological interventions (e.g., ginger) may be utilized to reduce the risk of PONV.
Patient and Family Education:Comprehensive patient and family education regarding preoperative preparations, perioperative care, pain management strategies, and expected postoperative outcomes are provided to promote active participation and engagement in the recovery process.
Standardized Care Pathways: Standardized care pathways and protocols are developed to ensure consistent delivery of care and adherence to ERAS principles across the perioperative period. Multidisciplinary collaboration and communication are essential for successful implementation and optimization of ERAS protocols in pediatric surgery.