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Perioperative fluid therapy in children: a survey of current prescribing practice

C Way1, R Dhamrait, A Wade

  • 1Department of Anaesthesia, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO16 6YD, UK.

British Journal of Anaesthesia
|July 29, 2006
PubMed

Insights

Many anaesthetists prescribe hypotonic fluids, increasing children's risk of hyponatraemia. Few departments have fluid policies, and national guidance is needed to ensure safe perioperative fluid therapy for pediatric patients.

Area of Science:

  • Pediatric Anesthesiology
  • Pediatric Fluid Management
  • Iatrogenic Hyponatremia

Background:

  • Perioperative fluid therapy in children can lead to iatrogenic hyponatraemia.
  • Concerns exist regarding the use of dextrose 4%/saline 0.18% in pediatric patients.
  • Current fluid prescribing practices and awareness of guidelines among anaesthetists are not well-understood.

Purpose of the Study:

  • To survey anaesthetists' current fluid prescribing practices during the perioperative period.
  • To assess the availability of departmental fluid protocols.
  • To determine anaesthetists' awareness of Royal College of Paediatrics and Child Health (RCPCH) concerns.

Main Methods:

  • A questionnaire survey was distributed to 477 consultant anaesthetists in two UK training areas.
  • Responses from 203 anaesthetists who anaesthetized children were analyzed.
  • Data collected included fluid prescription habits, departmental policies, and awareness of RCPCH guidelines.

Main Results:

  • 67.7% of departments lacked a local fluid prescription policy, and 58.1% of anaesthetists were unaware of RCPCH concerns.
  • Hypotonic dextrose saline solutions were prescribed intraoperatively by 60.1% and postoperatively by 75.2% of anaesthetists.
  • Anaesthetists in specialist pediatric hospitals were more likely to prescribe isotonic fluids intraoperatively and restrict fluids postoperatively.

Conclusions:

  • The prevalent use of hypotonic dextrose saline solutions may place children at risk of iatrogenic hyponatraemia.
  • Departmental protocols for perioperative fluid prescription in children are infrequently implemented.
  • There is a need for national guidance on pediatric perioperative fluid management.
Abstract

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