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Basics of fluid and blood transfusion therapy in paediatric surgical patients
1Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Perioperative fluid and blood transfusion therapy for pediatric patients requires meticulous management due to a narrow margin for error. This review covers essential concepts and recent guidelines for pediatric perioperative care.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Pediatric Surgery
Background:
- Perioperative fluid, electrolyte, and blood transfusion management in children presents unique challenges due to varying opinions and complex clinical applications.
- Controversies exist regarding traditional glucose-containing hypotonic maintenance crystalloid solutions for pediatric perioperative fluid therapy.
- Paediatric intraoperative transfusion, especially massive transfusion protocols, is complex due to patient blood volume dynamics.
Purpose of the Study:
- To review fundamental concepts of perioperative fluid and blood transfusion therapy in pediatric patients.
- To present recent recommendations and guidelines for managing fluid and blood products in pediatric perioperative care.
- To clarify best practices amidst evolving clinical applications and controversies.
Main Methods:
- Literature search conducted on Pubmed, Ovid MEDLINE, HINARI, and Google Scholar without date restrictions.
- Search terms included 'Perioperative', 'fluid therapy', 'paediatrics', 'blood transfusion', 'electrolyte disturbances', and 'guidelines'.
- Included English-translated articles to ensure accessibility and relevance.
Main Results:
- Identified key considerations for crystalloid, colloid, and blood component therapy to maintain cardiovascular stability and tissue perfusion.
- Highlighted recent debates surrounding hypotonic crystalloid solutions in pediatric perioperative fluid management.
- Emphasized the complexity of massive blood transfusion protocols in pediatric patients.
Conclusions:
- Meticulous fluid, electrolyte, and blood transfusion management is critical in pediatric perioperative settings due to a limited safety margin.
- Current evidence and guidelines support refined approaches to perioperative fluid and transfusion therapy in children.
- Further research and consensus are needed to address ongoing controversies in pediatric perioperative fluid management.
Abstract:
Perioperative fluid, electrolyte and blood transfusion therapy for infants and children can be confusing due the numerous opinions, formulas and clinical applications, which can result in a picture that is not practical and is often misleading. Perioperatively, crystalloids, colloids and blood components are required to meet the ongoing losses and for maintaining cardiovascular stability to sustain adequate tissue perfusion. Recently controversies have been raised regarding historically used formulas and practices of glucose containing hypotonic maintenance crystalloid solutions for perioperative fluid therapy in children. Paediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss ≥ one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. A meticulous fluid, electrolyte and blood transfusion management is required in paediatric patients perioperatively because of an extremely limited margin for error. This article reviews the basic concepts in perioperative fluid and blood transfusion therapy for paediatric patients, along with recent recommendations. For this review, Pubmed, Ovid MEDLINE, HINARI and Google scholar were searched without date restrictions. Search terms included the following in various combinations: Perioperative, fluid therapy, paediatrics, blood transfusion, electrolyte disturbances and guidelines. Only articles with English translation were used.
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