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Intraoperative hyponatremia during craniofacial surgery.

K Rando1, G Zunini, A Negroto

  • 1National Craniofacial Surgery Unit & Department of Anesthesia, University Hospital, Montevideo, Uruguay.

Paediatric Anaesthesia
|February 25, 2009
PubMed
Summary

Intraoperative hyponatremia (low sodium levels during surgery) is common in pediatric craniofacial surgery, even with careful fluid management. Anesthesiologists must monitor for this complication.

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Area of Science:

  • Pediatric Anesthesiology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Hyponatremia is a significant cause of morbidity in hospitalized children.
  • Intraoperative hyponatremia poses a risk during pediatric surgical procedures.
  • Craniofacial surgery in children presents unique challenges for fluid and electrolyte management.

Purpose of the Study:

  • To determine the incidence and severity of intraoperative hyponatremia in pediatric craniofacial surgery.
  • To identify risk factors associated with intraoperative hyponatremia in this patient population.
  • To inform anesthetic management strategies for craniofacial procedures.

Main Methods:

  • Retrospective analysis of 107 pediatric patients undergoing primary craniofacial surgery (1994-2008).
  • All intravenous fluids maintained a minimum sodium concentration of 140 mmol/L.
  • Hyponatremia was classified as severe (< or =125 mmol/L), moderate (126-130 mmol/L), or mild (131-134 mmol/L).

Main Results:

  • Hyponatremia occurred in 54% of patients: mild (22%), moderate (19%), and severe (13%).
  • Mannitol administration, surgery type, duration, fluid replacement strategy, and urinary output were not associated with hyponatremia.
  • Most hyponatremia episodes (44%) were detected between postoperative hours 2 and 4.

Conclusions:

  • Despite strict protocols, intraoperative hyponatremia is frequent in pediatric craniofacial surgery.
  • The development of hyponatremia appears unrelated to mannitol administration.
  • Anesthesiologists should be vigilant in monitoring and managing potential hyponatremia during these procedures.