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Intraoperative fluid management in children - a comparison of three fluid regimens
1Department of Paediatric Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland. mcdosia@gmail.com.
Insights
Ringer's acetate is the safest intraoperative fluid for children, avoiding glucose and electrolyte imbalances. Hypotonic fluids like 5% glucose in water can cause dangerous hyperglycemia and hyponatremia in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Intraoperative Fluid Management
- Pediatric Endocrinology
Background:
- Perioperative fluid therapy is critical for pediatric patient safety.
- Inappropriate fluid management has led to severe complications, including neurological damage and death in children.
- Understanding the impact of intraoperative fluids on pediatric metabolic parameters is essential.
Purpose of the Study:
- To evaluate the effects of different intraoperative fluid solutions on serum glucose, electrolytes, and osmolality in children.
- To compare the safety and metabolic impact of 5% glucose in water (G5W), 3.33% glucose in 0.3% NaCl (GNaCl), and Ringer's acetate (RA) solutions.
- To identify optimal fluid choices for minimizing adverse metabolic changes during pediatric surgery.
Main Methods:
- A prospective, randomized, open-label study involving 91 children (ASA I-II) undergoing elective ENT surgery.
- Participants were assigned to receive G5W, GNaCl, or RA solutions.
- Serum glucose, sodium, potassium, phosphate, and osmolality were measured pre-anesthesia, post-surgery, and 60 minutes later.
Main Results:
- Postoperative hyperglycemia occurred in 94% of G5W and 37% of GNaCl groups; glucose increased in all groups.
- Hyponatremia was observed in 36% of G5W and 3.7% of GNaCl patients.
- Ringer's acetate showed no significant changes in glucose or electrolytes, and osmolality remained stable, unlike G5W and GNaCl which showed decreased osmolality.
Conclusions:
- Ringer's acetate is the safest intraoperative fluid for pediatric elective surgery due to its lack of significant impact on glucose and electrolyte levels.
- Hypotonic fluids, including 5% glucose in water and potentially 3.33% glucose in 0.3% NaCl, should be avoided during intraoperative management in children.
- Careful selection of intraoperative fluids is crucial to prevent metabolic disturbances and ensure patient safety in pediatric surgical settings.
Background:
Fluid therapy is essential for safe perioperative management. Numerous reports of serious complications, including brain damage and death of children, as a result of inappropriate fluid management, have been published. The aim of this study was to assess the effects of intraoperative fluids on serum glucose and electrolytes concentrations as well as serum osmolality.
Methods:
91 children, ASA I and II, undergoing elective ENT surgery were enrolled to this prospective, randomized, open-label study. They were randomly assigned to receive: group G5W: 5% glucose in water solution, group GNaCl: 3.33% glucose in 0.3% NaCl, and group RA: Ringer's acetate. Serum glucose, sodium, potassium, phosphate concentrations and serum osmolality were analysed before induction of anaesthesia, immediately after completion of surgery and 60 min later.
Results:
Postoperative hyperglycaemia was observed in 94% of children in group G5W and in 37% of group GNaCl. In all the groups glucose concentration increased significantly after surgery. Postoperative hyponatraemia occurred in 36% of patients in the group G5W, and in 3.7% in the group GNaCl. Neither hyperglycaemia nor hyponatremia occurred in the group RA. Postoperative osmolality decreased significantly in groups G5W and GNaCl and remained unchanged in the group RA.
Conclusions:
Ringer's acetate did not cause significant changes in glucose and electrolyte concentrations, so it seems to be the safest for intraoperative use in children undergoing elective surgery. Hypotonic fluids may cause hyperglycaemia and hyponatraemia so they should be avoided intraoperatively.
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