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Pediatric perioperative fluid management

Amit Mathew1, Ekta Rai1

  • 1Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India.

Saudi Journal of Anaesthesia
|October 18, 2021
PubMed

Insights

Pediatric perioperative fluid management requires individualized care, moving beyond outdated formulas. Current evidence supports tailored approaches to prevent serious complications in critically ill children.

Area of Science:

  • Pediatric Anesthesiology
  • Pediatric Critical Care Medicine
  • Intravenous Fluid Therapy

Background:

  • Appropriate fluid management is crucial for tissue perfusion and homeostasis in perioperative and critically ill children.
  • The heterogeneity of the pediatric population necessitates individualized fluid management strategies.
  • Traditional fluid calculation formulas, like the Holiday and Segar, are based on outdated studies and raise concerns about potential complications such as hyponatremia and hyperglycemia.

Purpose of the Study:

  • To provide a historical perspective on pediatric fluid management.
  • To present a current evidence-based approach to perioperative fluid management in children.
  • To address concerns regarding complications associated with traditional fluid therapy methods.

Main Methods:

  • A comprehensive literature search was conducted using PubMed.
  • Keywords included 'children', 'intravenous fluid therapy', 'crystalloids', 'colloids', 'fluid homeostasis', 'blood loss', 'estimation of blood loss', 'blood loss management', and 'perioperative fluid'.
  • Articles were reviewed to synthesize historical and current evidence.

Main Results:

  • The Holiday and Segar formula, widely used for decades, is based on studies from over 70 years ago on healthy children.
  • Concerns exist regarding the safety of this formula, with potential for hyponatremia and hyperglycemia, leading to neurological damage or mortality.
  • A shift towards individualized, physiology-based fluid management is indicated.

Conclusions:

  • Perioperative fluid management in children must consider individual physiology, pathology, and specific needs.
  • Outdated fluid calculation methods may lead to adverse outcomes.
  • An evidence-based, tailored approach is essential for optimizing fluid therapy in pediatric patients.

Keywords:
Cerebral edemacolloidscrystalloidsfastingfluid isotonicintraoperativemanagementpediatricsperioperativepostoperative

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