Anesthesia, Surgery
Conditions
Keywords
enhanced recovery after surgery, major intestinal surgery
Brief summary
Perioperative management of pediatric patients with gastrointestinal diseases involves a fairly length process and which can lead to rapid deterioration even death. Preoperative management includes preoperative fasting for such a long time, usage of drains and tubes and post-operative bed rest for a long time which can cause pain, stress, and slowing down the recovery time for normal bowel function, thus further prolonging the patient's stay in hospital. Enhanced recovery after surgery (ERAS) is a concept that seeks faster recovery times for pediatric patients and shortens the length of hospital stay while still improving postoperative outcomes. The ERAS modification protocol aims to optimize inpatient care and minimize patient discomfort. Studies show that implementing the modified ERAS protocol can reduce the duration of hospitalization and the incidence of postoperative complications as well as speedy recovery. However, currently the standard ERAS protocol is difficult to apply to pediatric patients. This study will determine the comparison of the effectiveness of the ERAS modification protocol with the standard protocol in reducing length of stay and improving postoperative outcomes for pediatric patients at RSCM who underwent major gastrointestinal surgery using the ERAS modification method.
Detailed description
Perioperative management of pediatric patients with gastrointestinal diseases involves a fairly length process and which can lead to rapid deterioration even death. Preoperative management includes preoperative fasting for such a long time, usage of drains and tubes and post-operative bed rest for a long time which can cause pain, stress, and slowing down the recovery time for normal bowel function, thus further prolonging the patient's stay in hospital. Enhanced recovery after surgery (ERAS) is a concept that seeks faster recovery times for pediatric patients and shortens the length of hospital stay while still improving postoperative outcomes. ERAS was first introduced by a Danish surgeon, Henrik Kehlet in the 1990s to reduce perioperative stress and organ dysfunction in surgical patients. ERAS is an evidence-based technique and combines and optimizes various multidisciplinary methods used in conventional surgical management, includes surgery, anesthesia, nursing, and nutrition. ERAS emphasizes perioperative preparation including preoperative counseling, limited time in preoperative fasting, optimal anesthesia, minimally invasive techniques, immediate postoperative oral nutrition and mobilization, and non-routine use of drainage and surgical tubes. The ERAS modification protocol aims to optimize inpatient care and minimize patient discomfort. Studies show that implementing the modified ERAS protocol can reduce the duration of hospitalization and the incidence of postoperative complications as well as speedy recovery. However, currently the standard ERAS protocol is difficult to apply to pediatric patients because several conditions are not possible in pediatric patients, for example, administering anticoagulants, post-operative fasting, etc., thus requiring modifications that are tailored to the characteristics of the patients at Ciptomangunkusumo Hospital. Children experience a more complex surgical stress response than adult patients. Conventional perioperative management in children often results in greater physical stress. Therefore, perioperative management in children needs to be optimized.
Interventions
PROCEDUREModified Enhanced Recovery After Surgery Protocol
This study is to determine the comparison of the effectiveness of the ERAS modification protocol with the standard protocol in reducing length of stay and improving postoperative outcomes for pediatric patients at RSCM who underwent major gastrointestinal surgery using the ERAS modification method. This study is a single-blind clinical trial. Research subjects will be randomly divided into two groups, namely the group who underwent surgery with the ERAS modification protocol and the group who underwent surgery without the ERAS modification protocol. Modified ERAS protocol will be applied during perioperative
Sponsors
Indonesia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
1 Months to 2 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 1 month to 2 years * The patient underwent major gastrointestinal surgery * ASA 1 and 2 physical status * The patient will undergo elective lower abdominal surgery with general and regional anesthesia
Exclusion criteria
* Patients with cyanotic congenital heart defects * Patients with metabolic disorders * Patients with decreased consciousness * Patients with severe cognitive impairment * Patients with relaparotomy due to surgical complications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of stay | The timeframe is calculated from when the patient undergoes preoperative assessment until discharge from the hospital, up to 3 months. | Patients' length of stay in the hospital, measured in days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood glucose level (mg/dL) | The time frame includes 1 day before surgery (preoperative), during surgery (intraoperative), and on the 3rd and 5th days after surgery (postoperative) | Blood glucose levels measured and compared during the preoperative, intraoperative, and postoperative periods |
| Blood electrolyte levels (Na, K, Cl) | Blood electrolyte levels assessed 1 day before surgery (preoperative) and on the 3rd day after surgery (postoperative) | Blood electrolyte levels assessed during the preoperative and postoperative periods |
| Oral Nutrition Initiation Time | The time frame is calculated from the end of the surgery and will be evaluated up to the time of the patient's discharge from the hospital | The time when the patient begins receiving oral nutrition, starting with clear fluids. Oral nutrition initiation time will be measured in hours |
| Time to mobilization | The time frame is calculated from the end of surgery and will be evaluated up to the time of the patient's discharge from the hospital | The time when the patient begins mobilization, which includes turning to the right and left sides, sitting, walking, and eventually resuming preoperative activities without pain or discomfort. The mobilization time is measured in days |
Countries
Indonesia
Outcome results
None listed