Fluid replacement in craniofacial pediatric surgery: normal saline or ringer's lactate?

Area of Science:

• Pediatric Anesthesiology
• Intravenous Fluid Therapy
• Craniofacial Surgery

Background:

• Pediatric craniofacial surgery necessitates substantial intravenous fluid replacement.
• Commonly used fluids, normal saline (NS) and Ringer's lactate (RL), have distinct effects on ionic balance.
• Understanding fluid-related acid-base and electrolyte changes is crucial for patient management.

Purpose of the Study:

• To compare the acid-base and electrolyte outcomes between NS and RL in pediatric craniofacial surgery.
• To determine if fluid choice influences the incidence of acidosis and hyponatremia.
• To guide optimal fluid management strategies in this patient population.

Main Methods:

• A retrospective study involving 122 children under 5 years undergoing craniofacial surgery.
• Patients were divided into two groups: 63 receiving NS and 59 receiving RL.
• Analysis of blood gases and plasma electrolytes (sodium, potassium) at two time points post-induction.

Main Results:

• Metabolic acidosis was significantly more frequent in the NS group compared to the RL group (P-1: 66% vs. 26%; P-2: 80% vs. 37%).
• Severe acidosis and base excess < -5 were also higher in the NS group.
• The incidence of hyponatremia was comparable between the NS and RL groups across both study periods.

Conclusions:

• Ringer's lactate may be a preferred crystalloid over normal saline for pediatric craniofacial surgery.
• RL use is associated with a lower incidence of metabolic acidosis.
• RL does not increase the risk of hyponatremia compared to NS in this surgical context.