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Perioperative fluid management in children: can we sum it all up now?
Robert Sümpelmann1, Karin Becke2, Rolf Zander3
1Clinic of Anaesthesiology, Hannover Medical School, Hannover.
Insights
Balanced isotonic electrolyte solutions are recommended for pediatric anesthesia fluid management. These solutions enhance patient safety and metabolic stability during surgery, improving outcomes.
Area of Science:
- Pediatric Anesthesia
- Intravenous Fluid Therapy
- Perioperative Care
Background:
- Perioperative fluid management in children is complex and critical for preventing adverse outcomes.
- Historical debates surround intravenous fluid composition and type during pediatric anesthesia.
Purpose of the Study:
- To review historical and current recommendations for pediatric perioperative fluid management.
- To focus on physiological principles for safe and effective fluid administration in children.
Main Methods:
- Review of historical and recent literature on pediatric fluid management.
- Analysis of physiological data related to fluid balance and electrolyte composition.
Main Results:
- Optimized fasting and clear fluid intake improve patient comfort and hemodynamics.
- Balanced isotonic electrolyte solutions are safer than hypotonic or 0.9% saline solutions.
- Intraoperative glucose infusion prevents hypoglycemia; colloids can manage circulatory instability.
Conclusions:
- Physiologically balanced isotonic electrolyte solutions are beneficial for homeostasis in pediatric patients.
- These solutions offer a wide safety margin, even with accidental hyperinfusion.
- They help normalize patient status, particularly those with pre-existing imbalances.
Purpose Of Review:
The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative fluid management in children may lead to serious complications and a negative outcome. Therefore, in this review, historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy.
Recent Findings:
Optimized fasting times and liberal clear fluid intake until 1 h improve patient comfort and metabolic and haemodynamic condition after induction of anaesthesia. Physiologically composed balanced isotonic electrolyte solutions are safer than hypotonic electrolyte solutions or saline 0.9% to protect young children against the risks of hyponatraemia and hyperchloraemic acidosis. For intraoperative maintenance infusion, addition of 1-2% glucose is sufficient to avoid hypoglycaemia, lipolysis or hyperglycaemia. Modified fluid gelatine or hydroxyethyl starch in balanced electrolyte solution can safely be used to quickly normalize blood volume in case of perioperative circulatory instability and blood loss.
Summary:
Physiologically composed balanced isotonic electrolyte solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in patients with preexisting imbalances and have a wide margin of safety in case of accidental hyperinfusion.
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