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The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy
Peggy Vogt1,2, Renee Tolly1,2, Matt Clifton3
1Department of Pediatric Anesthesia and Pain Medicine, Egleston Hospital, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30322, USA.
Children (Basel, Switzerland)
|November 11, 2022
Summary
Optimizing pain control and bowel function after the Kasai procedure (hepatoportoenterostomy) in infants is achievable. This study suggests an enhanced recovery protocol can improve outcomes for these young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Anesthesiology
Background:
- The Kasai procedure (hepatoportoenterostomy) presents challenges in balancing post-operative pain control, respiratory depression, and bowel function in infants.
- Optimizing these factors is crucial for successful patient recovery.
Observation:
- A retrospective review of 12 infants undergoing the Kasai procedure was conducted.
- Patients received multimodal pain management, balanced fluid resuscitation, and blood products as needed.
- All infants were extubated in the operating room and transferred to the surgical floor without immediate complications.
Findings:
- Return of bowel function occurred by post-operative day 2, with enteral feeds initiated by post-operative day 3 for all patients.
- One patient experienced a presumed opioid overdose requiring brief oxygen supplementation.
- Multimodal pain management and fluid strategies appear effective in this cohort.
Implications:
- Simultaneous optimization of pain, respiratory, and bowel function is feasible in infants undergoing the Kasai procedure.
- An enhanced recovery protocol is proposed to further improve outcomes in this fragile population.
- Larger, prospective studies are needed to validate these findings and establish robust recommendations.
