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Complications of excessive operative fluid administration in children receiving steroids for inflammatory bowel
Insights
Adolescents on steroids undergoing intestinal surgery may experience dangerous fluid retention and hypertension. Caution with intravenous fluids and early diuretic use are recommended for these patients.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Chronic steroid therapy is common for pediatric inflammatory bowel disease (IBD).
- Major intestinal surgery presents unique perioperative challenges.
- Steroids can affect fluid balance and cardiovascular responses.
Purpose of the Study:
- To investigate the impact of chronic steroid therapy on fluid management during major intestinal surgery in adolescents.
- To compare perioperative complications in steroid-treated versus non-steroid-treated adolescent surgical patients.
- To identify optimal fluid management strategies for steroid-dependent adolescents undergoing major surgery.
Main Methods:
- Retrospective analysis of 25 adolescents on chronic steroids undergoing major intestinal surgery.
- Comparison with 10 steroid-naïve adolescents undergoing similar procedures.
- Monitoring of intraoperative and postoperative fluid balance, blood pressure, and adverse events.
Main Results:
- All steroid-treated adolescents experienced vasodilation, hypotension, and significant fluid retention, leading to hypertension, pulmonary edema, and seizures.
- Non-steroid-treated adolescents had higher urine output and fewer complications.
- Aggressive crystalloid administration exacerbated water retention in steroid-treated patients.
Conclusions:
- Adolescents on chronic steroids undergoing major intestinal surgery are at high risk for perioperative fluid overload.
- Excessive intravenous fluid administration should be approached with caution in this population.
- Early diuretic administration may be beneficial in managing perioperative fluid retention.
Abstract:
Twenty-five adolescents receiving chronic steroid therapy for inflammatory bowel disease underwent major intestinal surgery and each experienced vasodilation during induction of anesthesia. Systemic hypotension occurred in each patient and was treated by large volumes of intravenous crystalloid solution which caused intraoperative and postoperative water retention with resultant hypertension as well as occasional pulmonary edema and seizures. Ten adolescents who did not receive steroids and who underwent similar operations had higher urine outputs during and immediately after surgery, but did not experience these complications. Intravenous fluid administration in excess of maintenance requirements and calculated fluid losses should be given with caution to children receiving high-dose steroids who undergo major intestinal surgery. Perioperative fluid retention under those circumstances may be best treated with early diuretic administration.
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