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Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here?

Ann G Bailey1, Peggy P McNaull, Edmund Jooste

  • 1Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA. abailey@aims.unc.ed

Anesthesia and Analgesia
|December 4, 2009
PubMed

Insights

Pediatric perioperative fluid management, based on 50-year-old guidelines, may lead to complications like hyperglycemia and hyponatremia. Current practices require reassessment for surgical patients, considering isotonic vs. hypotonic fluid choices.

Area of Science:

  • Pediatric Anesthesiology
  • Pediatric Surgery
  • Pediatric Critical Care

Background:

  • Parenteral maintenance fluid guidelines for children, established over 50 years ago by Holliday and Segar, heavily influence current perioperative fluid administration practices.
  • The glucose, electrolyte, and intravascular volume needs of pediatric surgical patients may differ significantly from the original study population.
  • Traditional hypotonic fluid use, based on older recommendations, can lead to postoperative complications such as hyperglycemia and hyponatremia in pediatric surgical patients.

Purpose of the Study:

  • To critically evaluate the historical basis of pediatric perioperative fluid management.
  • To review current crystalloid and colloid fluid options for pediatric surgical patients.
  • To address the controversy surrounding isotonic versus hypotonic fluid administration in the postoperative period for children.

Main Methods:

  • Historical review of pediatric fluid management principles.
  • Analysis of current literature on crystalloid fluid administration in pediatric surgery.
  • Review of evidence regarding colloid use in pediatric patients.

Main Results:

  • The original Holliday and Segar guidelines may not be optimal for all pediatric surgical patients.
  • Complications like hyperglycemia and hyponatremia are associated with traditional hypotonic fluid use.
  • There is ongoing debate regarding the preferred fluid type (isotonic vs. hypotonic) in the postoperative pediatric surgical setting.

Conclusions:

  • Pediatric perioperative fluid management requires careful consideration beyond historical guidelines.
  • The choice between isotonic and hypotonic fluids necessitates a nuanced approach based on individual patient needs.
  • Further research and updated guidelines are needed for optimal fluid management in pediatric surgical patients.

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