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Objective To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients.Methods Sixty pediatric patients of both sexes with hydronephrosis,aged 3-12 yr,of American Society of Anesthesiologists physical status I or Ⅱ,undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019,were divided into 2 groups using a random number table method:control group (group C,n =28) and ERAS group (n =32).In ERAS group,preoperative ERAS education was carried out,the time of preoperative food and water deprivation was shortened,pediatric patients drank glucose water at 2 h before surgery,anesthetic regimen was optimized,lung protective ventilation and target-directed fluid therapy were performed,and intraoperative warming and multi-mode antiemetic measures were carried out during operation,and multi-mode analgesic measures were taken after operation,and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C,the traditional concept was adopted for perioperative management.Immediately after tracheal intubation,at 30 min and 1 and 2 h after establishing pneumoperitoneum,at 5 min after the end of pneumoperitoneum and at 5 min after extubation,the airway peak pressure and tidal volume were recorded,and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation,time of first intake,the first postoperative off-bed time,the first flatus time,time of pulling out the ureter and drainage tube,and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4,fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading,and postoperative complications included nausea and vomiting,abdominal distension,abdominal pain,incision infection,abdominal infection,anastomotic leakage,fever,etc.Results Compared with group C,the preoperative food and water deprivation time was significantly shortened,the time of postoperative extubation was prolonged,the postoperative length of hospital stay,time of first intake,the first postoperative off-bed time,the first flatus time,and time of pulling out the ureter were shortened,airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum,arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P＜0.05 or 0.01),and no significant change was found in the incidence of postoperative agitation,nausea and vomiting,incision infection,abdominal infection or fever in group ERAS (P＞0.05).No intraoperative adverse cardiovascular events were found,and no pediatric patients required rescue analgesia after operation in two groups.Conclusion ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.
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Objective@#To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients.@*Methods@#Sixty pediatric patients of both sexes with hydronephrosis, aged 3-12 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019, were divided into 2 groups using a random number table method: control group (group C, n=28) and ERAS group (n=32). In ERAS group, preoperative ERAS education was carried out, the time of preoperative food and water deprivation was shortened, pediatric patients drank glucose water at 2 h before surgery, anesthetic regimen was optimized, lung protective ventilation and target-directed fluid therapy were performed, and intraoperative warming and multi-mode antiemetic measures were carried out during operation, and multi-mode analgesic measures were taken after operation, and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C, the traditional concept was adopted for perioperative management.Immediately after tracheal intubation, at 30 min and 1 and 2 h after establishing pneumoperitoneum, at 5 min after the end of pneumoperitoneum and at 5 min after extubation, the airway peak pressure and tidal volume were recorded, and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation, time of first intake, the first postoperative off-bed time, the first flatus time, time of pulling out the ureter and drainage tube, and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4, fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading, and postoperative complications included nausea and vomiting, abdominal distension, abdominal pain, incision infection, abdominal infection, anastomotic leakage, fever, etc.@*Results@#Compared with group C, the preoperative food and water deprivation time was significantly shortened, the time of postoperative extubation was prolonged, the postoperative length of hospital stay, time of first intake, the first postoperative off-bed time, the first flatus time, and time of pulling out the ureter were shortened, airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum, arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P<0.05 or 0.01), and no significant change was found in the incidence of postoperative agitation, nausea and vomiting, incision infection, abdominal infection or fever in group ERAS (P>0.05). No intraoperative adverse cardiovascular events were found, and no pediatric patients required rescue analgesia after operation in two groups.@*Conclusion@#ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.
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Objective To summarize the experience of patient positing,port placements setting and robot cart docking in pediatric robot-assisted laparoscopic upper urinary tract operations.Methods From March 2017 to December 2017,140 robot-assisted laparoscopic upper urinary tract procedures were performed in our institution,including 110 cases of pyeloplasty,15 upper pole heminephroureterectomy,12 simple nephrectomy and 3 adrenalectomy.There were 103 males and 37 females with a range age from 1 month to 18 years.The assistant surgeon was adjacent to the instrument nurse,and patients were placed in a supine position with 60°-80° inclination and keep the legs low to the body.Room setup and patient positioning were similar to the traditional laparoscopic surgery.Semi-hidden incision technique was used in 140 patients:the camera port was placed umbilicus,two additional arm ports (one 5 mm and one 8 mm) were placed under direct vision,the 8 mm arm port was placed on the line of a Pfannenstiel incision and the 5 mm arm port was placed below the Xiphoid along the midline.Finally,a 3 or 5 mm assistant port was placed approximately 3 cm lateral to the inferior arm port,the line of a Pfannenstiel incision.Results The average time was (11.5 ± 3.2) min (10.5-16.5 min) from skin incision to robot cart docking completed.All surgeries were successfully completed without open conversion.One patient required an additional assist port for severe adhesion after the previously open surgery,there was no injury to other viscera.Average operative time was (146.9 ± 48.7)min (78-259 min) and average post-operative hospitalization time was (5.7 ± 1.4) d(4-10 d),respectively.There was no visual scar on abdominal 6 weeks postoperatively,and all parents made comments about their satisfaction with the cosmetic appearance.All operations got complete success at a mean follow up of 6 (1-9) months.Conclusions A good room setup,patient positioning and the semi-hidden incision technique port placements are maintaining the safety of the patient,avoiding compression injuries,allowing maximum mobility of the robotic arms,and facilitating a smooth and efficient surgery,and improving post-operative recovery.
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AIM To study the characteristic of th e rapidly activating component (Ikr) and the slowly activating compone nt (Iks) of the delayed rectifier K+ current in guinea pig hypertrop hi ed ventricular myocytes induced by thyroxine. METHOD The whole c ell patch clamp techniques were used. RESULTS In hypertrophied ve ntricular myocytes, the magnitude of IKr and IKs were great ly augmented with more positive depolarizations, and the degree of increase of IKr tail and IKs were greater than that of IKr an d IKs tail, respectively. By measuring the amplitude of tail currents which reflected the degree of activation, the activation curve of IKs was shifted toward more negative potential, but that of IKr was marked ly unaffected in hypertrophied myocytes. CONCLUSION Hypertrophied ventricular myocytes induced by thyroxine obviously increased IKr and IKs.