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Incidence, Predictors, and Outcomes of Early Postoperative Dysnatremia After Pediatric Neurosurgery: A Prospective
Amruta Nirale1, Suparna Bharadwaj1, Sangeetha R Palaniswamy1
1Department of Neuroanaesthesia and Neurocritical Care, and Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Background:
Sodium abnormalities are frequent in the neuro intensive care unit (ICU) settings. Dysnatremia can also manifest in the perioperative period in neurosurgical patients and can lead to adverse consequences. The burden of dysnatremia following elective pediatric neurosurgery is unclear. Hence, we aimed to assess the incidence, risk factors, and outcomes of dysnatremia in children undergoing elective neurosurgeries.
Methods:
This was a single-center, prospective observational study in consecutive elective pediatric neurosurgical patients aged < 18 years. Perioperative data were collected for the first 3 postoperative days and included age, gender, weight, American Society of Anesthesiologists Physical Status classification, location of surgical pathology, preoperative sodium, intraoperative blood loss and transfusion, intraoperative fluid balance, balanced salt solution use, perioperative vomiting, steroid use, seizures, Glasgow coma scale score, duration of ICU and hospital stay, and in-hospital mortality. Hyponatremia was defined as serum sodium < 135 mEq/L, hypernatremia as serum sodium > 145 mEq/L, and dysnatremia as the presence of either hyponatremia or hypernatremia.
Results:
Six hundred sixty-eight children who underwent neurosurgery had perioperative sodium values assessed during the 22-month study period. The incidence of postoperative dysnatremia was 18.6% (124/668). In multivariate regression analysis, sellar/suprasellar region pathologies, preoperative dysnatremia, and higher blood loss were predictors of postoperative dysnatremia. Children with postoperative dysnatremia had a higher occurrence of seizures, neurological deterioration, and death, and longer ICU and hospital stays.
Conclusions:
About one-in-five children undergoing neurosurgery develop postoperative dysnatremia, and it is predicted by preoperative dysnatremia, sellar/suprasellar pathology, and higher blood loss. Dysnatremia is associated with poor clinical outcomes.
Study Registration:
Clinical Trials Registry-India: CTRI/2022/01/039795.
