Intraoperative fluid and glucose management in children

Intraoperative fluid therapy in neonates

“…[19][20][21] In the neonate, there has been reluctance to switch to isotonic solutions due to concerns regarding the ability of the neonate to handle salt solutions. 22 This is despite a risk of hyponatremia, particularly in the premature infant.…”

“…Intraoperative glucose is no longer required in the maintenance fluid for the majority of children 1,19,30 The one group where there is uncertainty is the neonate.…”

Untitled

“…Before they are taken to the operating room, premature infants taking parenteral nutrition and fluids containing dextrose, low weight and high-risk newborns, and children having 3 hours longer duration of surgery such as cardiac surgery and receiving regional anesthesia carry high risk for hypoglycemia. Low concentration of (LRD 1 % or LR½ D 2.5 %) should be given to these patients in perioperative period [12]. Giving routine dextrose is not required except this group of children.…”

“…Hypoglycemia, if not treated, causes temporary neurological disorders.Hyperglycemia with anaerobic metabolism causes accumulation of lactate, ischemia and hypoxia, decrease in intracellular pH and cell death. In addition, hyperglycemia causes dehydration, electrolyte abnormalities and osmotic diuresis [12].…”

Anästhesiologische Aspekte in der Neu- und Frühgeborenenchirurgie

“…Als Erhaltungsbedarf verabreichen die Autoren eine Ringer-Laktat-Glukose-Mischung (entspricht einem Drittel Glukoselösung, 5ig, und zwei Drittel Ringer-Laktat-Lö-sung) mit 10 ml*h −1 *kgKG −1 . Engmaschige Blutzuckerkontrollen sind notwendig, um Hypo-und auch Hyperglykämien zu vermeiden [43]. Andere Zentren infundieren als Erhaltungsbedarf eine Ringer-LaktatLösung und parallel dazu eine hochprozentige Glukoselösung (40ig) via Dreiwegehahn; dies erlaubt, die Volumenund die Glukosezufuhr getrennt zu steuern.…”