在接受泌尿外科手术的儿童中管理术前焦虑和血栓预防：欧洲泌尿外科协会/欧洲儿科泌尿外科学会儿科泌尿外科指南的更新

IF 3.2 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-04-15 DOI:10.1016/j.euros.2025.02.006

Michele Gnech , Lisette ’t Hoen , Martin Skott , Guy Bogaert , Marco Castagnetti , Fardod O’Kelly , Josine Quaedackers , Yazan F. Rawashdeh , Uchenna Kennedy , Allon van Uitert , Yuhong Yuan , Marco Capecchi , Andrea Artoni , Gülhan Karaöz-Bulut , Niklas Pakkasjärvi , Berk Burgu , Anna Bujons , Mesrur Selcuk Silay , Christian Radmayr

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引用次数: 0

摘要

背景：关于在接受泌尿外科手术的儿童中预防焦虑和抗血栓管理的文献仍然有限，导致证据水平普遍较低。这些指南旨在根据欧洲泌尿外科协会(EAU)/欧洲儿科泌尿外科学会（ESPU）儿科泌尿外科指南小组的共识，提供一种实用的方法。目的作者旨在为2024年EAU/ESPU儿科泌尿外科指南小组提供关于儿童泌尿外科手术围手术期管理章节的更新。证据获取对从上次更新到2023年4月3日发表的所有相关出版物进行结构化文献综述。证据综合最重要的更新包括：焦虑和痛苦应该通过药物前治疗、分散注意力技术以及父母或照顾者在场等综合措施来预防或缓解。临床医生应根据患者的年龄、基础条件和心理状态选择合适的预用药。必须特别关注有“特殊需要”的儿科患者，包括患有影响其关系和认知能力的心理生理障碍的儿童。这一独特的人群需要精心定制围手术期管理。围手术期血栓栓塞事件在儿科人群中的发生率一般较低。关于是否在常规基础上进行术前凝血检查仍存在争议。新生儿和青少年围手术期血栓栓塞事件的风险高于其他儿童。由于缺乏高质量的循证数据，不推荐标准围手术期抗血栓预防。结论总结了儿童泌尿外科手术中焦虑的预防措施和抗血栓治疗的相关证据。在这份欧洲泌尿外科协会/欧洲儿科泌尿外科学会儿科泌尿外科指南的总结和更新中，我们提供了在接受泌尿外科手术的儿童中预防焦虑和抗血栓管理的实际考虑。

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Managing Preoperative Anxiety and Thromboprophylaxis in Children Undergoing Urological Procedures: An Update of the European Association of Urology/European Society for Paediatric Urology Guidelines on Paediatric Urology

Context

The literature on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures is still limited, resulting in a generally low level of evidence. These guidelines aim to provide a practical approach based on a consensus from the European Association of Urology (EAU)/European Society for Paediatric Urology (ESPU) Paediatric Urology Guidelines Panel.

Objective

The authors aim to provide the 2024 EAU/ESPU Paediatric Urology Guidelines Panel update of the chapter on perioperative management of urological procedures in children.

Evidence acquisition

A structured literature review was performed for all relevant publications published from the last update until April 03, 2023.

Evidence synthesis

The most important updates include the following: anxiety and distress should be prevented or relieved by combining measures such as premedication, distraction techniques, and presence of parents or caregivers. Clinicians should select the appropriate premedication depending on the patient’s age, underlying conditions, and psychological status. A particular focus must be placed on paediatric patients with “special needs”, including children with psychophysical disorders that impact their relational and cognitive abilities. This unique population requires carefully tailored perioperative management. The incidence of perioperative thromboembolic events in the paediatric population is generally low. Controversies still exist on whether to perform a preoperative coagulation panel test on a routine basis. Neonates and adolescents are at a higher risk of perioperative thromboembolic events than the other children. Standard perioperative antithrombotic prophylaxis is not recommended due to a lack of high-quality evidence-based data.

Conclusions

This paper is a summary of evidence on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.

Patient summary

In this summary and update of the European Association of Urology/European Society for Paediatric Urology guidelines on paediatric urology, we provide practical considerations for preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.

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