Anesthetic management for enhanced recovery after major surgery in children

Perioperative Enhanced Recovery After Surgery (ERAS) protocols, though originally created in adult surgery, are increasingly gaining applications in pediatric practice. This application addresses the unique challenge in children, who possess more complex surgical stress responses. The main goal of ERAS is to maximize postoperative recovery and improve clinical outcomes through a standardized multimodal perioperative care approach.

This review article integrates current literature and expert consensus regarding the use of ERAS principles in pediatric anesthetic care in the preoperative, intraoperative, and postoperative phases in children undergoing major surgery, also explores the implementation, benefits, and challenges of ERAS in pediatric patients, highlighting recent advancements and the impact of these protocols on recovery.

The key pillars of pediatric ERAS include preoperative education and dietary optimization, multimodal opioid-sparing analgesia (e.g., regional anesthesia, nonopioid systemic analgesics), minimally invasive surgery, and goal-directed fluid resuscitation. Postoperative care includes early enteral nutrition, early mobilization, and planned discharge. Existing evidence, although further emerging, indicates that adherence to these protocols is associated with significant benefits, including shorter hospital length of stay, reduced opioid consumption, reduced intraoperative fluid administration, and faster return to normal diet.

ERAS protocols implemented in pediatric anesthesia are successful in optimizing recovery by reducing complications, improving pain control, and reducing length of stay. Implementation is case-specific anesthetic planning and multidisciplinary collaboration, finally maximizing outcomes and improving satisfaction for parents and children.