Enhanced anaesthesia strategies for bladder exstrophy patients

Abstract

Background: Classic bladder exstrophy (CBE) is a significant congenital defect requiring extensive surgery and a lengthy recovery. There is a paucity of information based on formal studies validating best practices of anaesthesia care in bladder exstrophy patients. Enhanced recovery after surgery (ERAS) and prehabilitation are core principles that can improve surgical outcomes. The available literature suggests that more careful attention could be paid to presurgical optimisation. Perioperative care built on available ERAS and evidence-based practices may improve outcomes.

Methods: We present a summary and review of literature coupled with our experiences in a bladder exstrophy centre of excellence that focuses on the primary closure of CBE. We provide recommendations for ERAS and prehabilitation protocols. We review the potential implications of perioperative anaemia, blood transfusion, and the benefits of using antifibrinolytics intraoperatively. We discuss goal-directed fluid management and the importance of multimodal pain management.

Conclusion: Any team embarking on caring for a bladder exstrophy patient needs a comprehensive team within a bladder exstrophy regional centre of excellence, a multidisciplinary plan for perioperative care, and a multimodal approach to pain management. This perioperative plan should begin before surgery, and all team members should be informed about the evidence-based practices included in the pathway. Perioperative care should be planned, orchestrated, and executed to ensure optimal patient outcomes.