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Fluid, blood, and blood product management in the craniofacial patient
E Wilkinson1, J Rieff, H L Rekate
1Division of Neuroanesthesiology, Barrow Neurological Institute, Phoenix, Ariz. 85013.
Insights
Perioperative fluid management for pediatric craniofacial surgery is crucial. Using intravenous fluids with sodium content between 77-154 mEq/L helps maintain normal postoperative serum sodium levels, preventing complications like seizures.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neurosurgery
Background:
- Craniofacial surgical procedures in children require careful perioperative management.
- Maintaining electrolyte balance, particularly serum sodium, is critical post-surgery.
Purpose of the Study:
- To review the perioperative fluid management strategies in pediatric craniofacial surgery.
- To evaluate the impact of different intravenous fluid regimens on postoperative serum sodium levels.
- To establish recommendations for optimal fluid management to prevent hyponatremia.
Main Methods:
- Retrospective review of 56 pediatric patients undergoing craniofacial surgery.
- Analysis of perioperative intravenous fluid administration and postoperative serum sodium levels.
- Comparison of outcomes between different fluid regimens.
Main Results:
- Fluid regimens combining 5% dextrose in normal saline or Ringer's lactate with normal saline maintained normal postoperative sodium levels.
- A regimen using 5% dextrose with electrolyte No. 48 and normal saline resulted in lower mean sodium levels (130 mEq/L), with 9/18 patients below 130 mEq/L.
- Two patients developed seizures due to severe hyponatremia (122 and 121 mEq/L).
Conclusions:
- Intravenous fluid solutions with sodium content between 77 and 154 mEq/L are recommended for routine perioperative management of pediatric craniofacial patients.
- Careful selection of intravenous fluids is essential to avoid hyponatremia and associated complications such as seizures.
- Standardizing fluid management protocols can improve patient safety in this population.
Abstract:
This report is a retrospective review of the perioperative management of 56 children who underwent craniofacial surgical procedures. The use of a combination of 5% dextrose in normal saline or 5% dextrose in Ringer's lactate and normal saline resulted in postoperative sodium values in a normal range. In patients receiving a combination of 5% dextrose and electrolyte No. 48 and normal saline, the mean postoperative sodium level was 130 mEq/l with 9 of 18 patients below 130 mEq/l. Two patients in the series suffered clinical seizures on postoperative day 1 as a result of serum sodium levels of 122 and 121 mEq/l, respectively. We recommend that only solutions with a sodium content between 77 and 154 mEq/l be used routinely in the perioperative management of craniofacial patients.