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Published on: April 21, 2023
[Parenteral fluid therapy in the pediatric surgical patient]
1Department of Anesthesiology, The Jikei University School of Medicine, Tokyo 105-8461.
Insights
Perioperative fluid therapy for pediatric surgical patients needs reassessment. Traditional hypotonic fluids may cause complications; a goal-directed approach with crystalloids and colloids is recommended.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Pediatric Surgery
- Fluid and Electrolyte Balance
Context:
- Parenteral maintenance fluid therapy, based on Holliday and Segar's work, is commonly applied to pediatric surgical patients.
- Critically ill pediatric surgical patients have unique metabolic and fluid volume needs.
- Traditional hypotonic fluid regimens may lead to complications like hyperglycemia and hyponatremia postoperatively.
Purpose:
- To evaluate the appropriateness of traditional fluid therapy in pediatric surgical patients.
- To highlight potential complications associated with standard fluid management in this population.
- To advocate for a revised fluid management strategy in pediatric surgery.
Summary:
- Perioperative fluid therapy in pediatric surgical patients requires careful consideration beyond traditional maintenance guidelines.
- The use of hypotonic fluids may result in adverse outcomes such as hyperglycemia and hyponatremia.
- A shift towards rational, monitored, goal-directed fluid management using both crystalloids and colloids is proposed, mirroring adult surgical practices.
Impact:
- This revised approach aims to optimize metabolic homeostasis and intravascular volume in pediatric surgical patients.
- It seeks to prevent common postoperative complications associated with fluid therapy.
- The study encourages a more individualized and evidence-based fluid management strategy for pediatric surgical care.
Abstract:
Perioperative fluid therapy aims to provide water, electrolytes and calorie to maintain metabolic homeostasis. The landmark article in which Holliday and Segar proposed the rate and composition of parenteral maintenance fluids for hospitalized children is used to the fluid management for the pediatric surgical patient. Critically ill patients require meticulous intraoperative fluid management to avoid acidosis, hypoglycemia, hyponatremia, and hypocalcemia as well as to maintain adequate intravascular volume. The glucose, electrolyte, and intravascular volume requirements of the pediatric surgical patient may be quite different from the original population described, and consequently, use of traditional hypotonic fluids may cause complications, such as hyperglycemia and hyponatremia in the postoperative surgical patient. Routine intraoperative dextrose administration is no longer necessary. We should ultimately change our approach according to major intraoperative fluid shifts by rational, monitored, goal-directed combination of both crystalloid and colloid therapy, similar to that occurring in adult surgical patients.
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