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A randomised controlled trial of Hartmann's solution versus half normal saline in postoperative paediatric spinal
Mark G Coulthard1, Debbie A Long, Amanda J Ullman
1Academic Discipline of Paediatrics and Child Health, University of Queensland, Herston, QLD 4029, Australia. Mark_Coulthard@health.qld.gov.au
Insights
Children undergoing major surgery had a smaller drop in plasma sodium when given Hartmann's and 5% dextrose compared to 0.45% saline and 5% dextrose. Hartmann's solution is recommended for post-operative care in pediatric patients.
Area of Science:
- Pediatric intensive care
- Surgical fluid management
- Electrolyte balance in children
Background:
- Postoperative fluid management in children is critical for maintaining electrolyte balance.
- Understanding the impact of different intravenous fluid regimens on plasma sodium levels is essential.
- Major pediatric surgeries require careful consideration of fluid type and rate to prevent complications.
Purpose of the Study:
- To compare plasma sodium levels 16-18 hours post-surgery in pediatric patients receiving two different intravenous fluid regimens.
- To evaluate the incidence of hyponatremia and hypernatremia between the two fluid groups.
- To determine the preferred fluid strategy for major pediatric surgical cases.
Main Methods:
- A prospective, randomized, open-label study was conducted in a tertiary children's hospital.
- 82 pediatric patients undergoing major surgeries (spinal instrumentation, craniotomy, cranial vault remodeling) were included.
- Patients received either Hartmann's and 5% dextrose at full maintenance rate or 0.45% saline and 5% dextrose at two-thirds maintenance rate.
Main Results:
- Children receiving 0.45% saline and 5% dextrose had significantly lower mean postoperative plasma sodium levels (1.4 mmol/l lower, p=0.008).
- Hyponatremia (Na <135 mmol/l) occurred in 18% of patients on 0.45% saline, compared to 0% in the Hartmann's group (p=0.01).
- No instances of hypernatremia were observed in either group.
Conclusions:
- Hartmann's and 5% dextrose resulted in a smaller postoperative decrease in plasma sodium compared to 0.45% saline and 5% dextrose.
- The study suggests that Hartmann's and 5% dextrose, administered at the full maintenance rate, is preferable for pediatric patients post-major surgery.
- This fluid strategy may help prevent hyponatremia in the early postoperative period.
Objective:
To compare the difference in plasma sodium at 16-18 h following major surgery in children who were prescribed either Hartmann's and 5% dextrose or 0.45% saline and 5% dextrose.
Design:
A prospective, randomised, open label study.
Setting:
The paediatric intensive care unit (650 admissions per annum) in a tertiary children's hospital in Brisbane, Australia.
Patients:
The study group comprised 82 children undergoing spinal instrumentation, craniotomy for brain tumour resection, or cranial vault remodelling.
Interventions:
Patients received either Hartmann's and 5% dextrose at full maintenance rate or 0.45% saline and 5% dextrose at two-thirds maintenance rate.
Primary Outcome Measure:
plasma sodium at 16-18 h postoperatively; secondary outcome measure: number of fluid boluses administered.
Results:
Mean postoperative plasma sodium levels of children receiving 0.45% saline and 5% dextrose were 1.4 mmol/l (95% CI 0.4 to 2.5) lower than those receiving Hartmann's and 5% dextrose (p=0.008). In the 0.45% saline group, seven patients (18%) became hyponatraemic (Na <135 mmol/l) at 16-18 h postoperatively; in the Hartmann's group no patient became hyponatraemic (p=0.01). No child in either fluid group became hypernatraemic.
Conclusions:
The postoperative fall in plasma sodium was smaller in children who received Hartmann's and 5% dextrose compared to those who received 0.45% saline and 5% dextrose. It is suggested that Hartmann's and 5% dextrose should be administered at full maintenance rate postoperatively to children who have undergone major surgery in preference to hypotonic fluids.