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A novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months: a
Nicola Disma1, Leila Mameli, Angela Pistorio
1Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genoa, Italy.
Insights
Sterofundin is safer than normal saline for intraoperative fluid management in pediatric surgery, reducing chloride increases and metabolic acidosis risk. This study compared these isotonic solutions in young children undergoing major procedures.
Area of Science:
- Pediatric Anesthesiology
- Intraoperative Fluid Management
- Pediatric Surgery
Background:
- Isotonic electrolytic solutions are standard for intraoperative fluid management in children.
- Optimal composition of these solutions requires further definition.
Purpose of the Study:
- Compare plasma chloride concentration changes between Sterofundin and normal saline in pediatric patients undergoing major surgery.
- Evaluate secondary outcomes including other electrolyte changes, renal function, and hypoglycemia.
Main Methods:
- Randomized controlled open trial involving children aged 1-36 months undergoing major surgery.
- Exclusion criteria included preoperative electrolyte abnormalities, hemodynamic instability, and severe organ dysfunction.
- Primary outcome: change in plasma chloride concentration (ΔCl⁻); secondary outcomes: other electrolyte changes and hypoglycemia.
Main Results:
- Sterofundin use was associated with statistically less relevant changes in chloride (Cl⁻) and magnesium (Mg²⁺) compared to normal saline.
- Hyperchloremia risk increased significantly with large fluid volumes (>46.7 ml·kg⁻¹), irrespective of crystalloid type.
- Hypoglycemia was rare, occurring in only two patients.
Conclusions:
- Sterofundin demonstrates a safer profile than normal saline for pediatric patients during major surgery.
- Sterofundin helps protect against elevated plasma chlorides and subsequent metabolic acidosis.
- Fluid volume, not just crystalloid type, is a critical factor in hyperchloremia risk.
Background:
The use of isotonic electrolytic solutions for the intraoperative fluid management in children is largely recognized, but the exact composition still needs to be defined.
Objectives:
The primary objective of this randomized controlled open trial was to compare the changes in chloride plasma concentration using two intraoperative isotonic fluid regimens (Sterofundin vs. normal saline, both added with 1% of glucose) in children undergoing major surgery. Secondary objectives were to compare changes in other electrolytes, renal function, and the occurrence of hypoglycemia.
Methods:
Children aged between 1 and 36 months, scheduled for major surgery, were randomized to receive Sterofundin or saline during the intraoperative time. Children with preoperative electrolyte abnormalities, hemodynamic instability, and severe renal or hepatic dysfunction were excluded. The primary outcome was the Δ of Cl(-) (Δ = change in plasma concentration between post- and pre-infusion), and secondary outcomes included Δ of other electrolytes and intraoperative hypoglycemia.
Results:
A total of 240 patients were included in the two study sites and randomized to receive Sterofundin plus 1% glucose or normal saline plus 1% glucose, in a open fashion (229 were finally analyzed). Δ of Cl- and Mg++ was statistically less relevant in patients who received intraoperative Sterofundin, and Δ of the other electrolytes was comparable between the two study groups. Relative risk of hyperchloremia was significantly higher when large volumes were infused (over than 46.7 ml·kg(-1) ), regardless of type of crystalloid infused. Hypoglycemia occurred in two of 229 patients.
Conclusions:
Sterofundin is safer than normal saline in protecting young children undergoing major surgery against the risk of increasing plasma chlorides and the subsequent metabolic acidosis.
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