Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Abstract

Background: Fluid therapy is essential for safe perioperative management. Numerous reports of serious complications as a result of inappropriate fluid management, including brain damage and death of children, have been published. The aim of this study was to assess the effects of intraoperative fluids on serum glucose and electrolyte concentrations as well as serum osmolality. Methods: 91children, ASA I and II, undergoing elective ENT surgery were enrolled to this prospective, randomized, open-label study. They were randomly assigned to receive: group G5W: 5% glucose in water solution, group GNaCl: 3.33% glucose in 0.3% NaCl, and group RA: Ringer's acetate. Serum glucose, sodium, potassium, phosphate concentrations and serum osmolality were analysed before the induction of anaesthesia, immediately following the completion of surgery and 60 minutes after that. Results: Postoperative hyperglycaemia was observed in 94% of children in group G5W and in 37% of group GNaCl. In all the groups glucose concentration increased significantly after surgery. Postoperative hyponatraemia occurred in 36% of patients in the group G5W, and in 3.7% in the group GNaCl. Neither hyperglycaemia nor hyponatraemia occurred in group RA. Postoperative osmolality decreased significantly in groups G5W and GNaCl and remained unchanged in group RA. Conclusions: As Ringer's acetate did not cause significant changes in glucose and electrolyte concentrations, it seems to be the safest for intraoperative use in children undergoing elective surgery. As hypotonic fluids may cause hyperglycaemia and hyponatraemia, they should be avoided intraoperatively.

Effect of using ringer's lactate, with and without addition of dextrose, on intra-operative blood sugar levels in infants undergoing facial cleft surgeries

“…Addition of dextrose in our study had significantly increased the incidence of intra-operative hyperglycemia to 50% as compared to only 12% when RL alone was used. This is in agreement with a previous study by Mierzewska-Schmidt[ 12 ] who compared the blood glucose values in three groups of children and found higher blood glucose values with glucose-containing solutions. The study differed from our study in that they used 5% glucose, 3.33% glucose, and Ringer's acetate as the intra-operative fluid.…”

Effect of hemoglobin content on cerebral oxygen saturation during surgery for scoliosis in pediatric patients

“…At the same time, transfusion of a red blood cell suspension to improve the hemoglobin concentration, and reduce the influence of hemoglobin loss and hemodilution on the oxygen supply to organs should be carried out according to the patient hemoglobin level. In addition, fresh frozen plasma may be infused according to the patient’s coagulation status [ 11 , 15 ]. When the hemoglobin concentration is low, the oxygen content is insufficient to meet the oxygen consumption requirements of the brain.…”

Efficacy and Safety of Isotonic and Hypotonic Intravenous Maintenance Fluids in Hospitalised Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…One of the studies included [40] compared isotonic fluid to hypotonic fluid at maintenance rates and hypotonic fluid at limited rates in a three-arm trial. Three other papers [47,53,56] compared isotonic fluid with two types of hypotonic fluids. We combined the data from the hypotonic treatment arm in our analysis.…”