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Balanced electrolyte solution with 1% glucose as intraoperative maintenance fluid in infants: a prospective study of

Ulf Lindestam1, Åke Norberg2, Peter Frykholm3

  • 1Department of Paediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

British Journal of Anaesthesia
|November 6, 2024
PubMed

Insights

Intravenous maintenance fluids with 1% glucose safely maintain normoglycaemia in infants undergoing surgery. This balanced electrolyte solution is a safe alternative for pediatric surgical patients, preventing hypoglycaemia.

Area of Science:

  • Pediatric Anesthesiology
  • Intravenous Fluid Therapy
  • Metabolic Homeostasis

Background:

  • Optimal intravenous fluid composition and infusion rates for pediatric surgical patients remain undefined.
  • Current guidelines suggest isotonic fluids with 1.0-2.5% glucose, but evidence in infants is limited.
  • This study addresses the safety of 1% glucose in balanced electrolyte solutions for infant surgical maintenance fluids.

Purpose of the Study:

  • To evaluate if normoglycaemia is maintained in infants receiving a balanced electrolyte maintenance infusion with 1% glucose.
  • To assess the safety and efficacy of this fluid regimen in pediatric surgical patients.
  • To provide evidence for optimal intravenous fluid therapy in infants undergoing surgery.

Main Methods:

  • Prospective, two-centre study involving 365 infants (1-12 months) undergoing surgery.
  • Intravenous maintenance fluid administered at 4-8 ml kg-1 h-1.
  • Intraoperative monitoring of plasma glucose, blood gas, and ketone bodies.

Main Results:

  • Median fluid infusion rate was 3.97 ml kg-1 h-1.
  • Mean plasma glucose increased from 5.3 mM to 6.1 mM; no hypoglycaemia (<3.0 mM) occurred.
  • Electrolyte and acid-base balance remained within normal ranges, with stable sodium levels.

Conclusions:

  • Balanced electrolyte solutions with 1% glucose are safe for maintenance infusion in infants undergoing surgery.
  • This fluid regimen effectively maintains glucose homeostasis and acid-base balance.
  • It represents a safe alternative to current recommendations for pediatric surgical fluid therapy.
Abstract

Keywords:
acid–base physiologyglucoseinfantsketone bodiesperioperative fluid managementsodium

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