Pediatric Intraoperative Fluid Therapy in Anesthesiology

“Maintenance” of a traditional stance

GIFTAHo; an improvement on GIFTASuP? New NICE guidelines on intravenous fluids.

Context: Dengue hemorrhagic fever (DHF) is characterized by the main clinical manifestations of high fever and hemorrhagic phenomena, so fluid resuscitation is needed. Aims: To analyze the use of fluid therapy in pediatrics with DHF. Methods: The analysis was conducted descriptively using retrospective data retrieved from medical records of pediatric patients who used fluid therapy from January 2021 to December 2022 at Universitas Airlangga Hospital. Results: A total of 60 samples were included in this study, and the types of fluid therapy used in dengue fever (DF) were Ringer dextrose 5% (RD5, 15%), asering-5 (2%), dextrose 5% + NaCL 0.45% (D5½NS, 43%), and dextrose monohydrate sodium chloride ¼ NaCl (D5¼NS, 3%). Meanwhile, RD5 (15%), asering-5 (10%), D5½NS (10%), and D5¼NS (2%) were used in DHF with the highest number of administrations of 1500-2000 mL for 3-7 days. Conclusions: The patient's condition at the time of discharge was 100% improved, as shown by laboratory data, including decreased hematocrit, increased platelets, and normal hemoglobin.

Medical Journal of AustraliaVolume 1, Issue 1 p. 14-14 Review Practical Fluid Therapy in Pediatrics First published: 01 January 1955 https://doi.org/10.5694/j.1326-5377.1955.tb37619.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Practical Fluid Therapy in Pediatrics, By Fontaine S. Hill, M.D.; 1954. Philadelphia and London: W. B. Saunders Company. Melbourne: W. Ramsay (Surgical), Limited. 9½″ × 6½″, pp. 296, with 20 illustrations. Price: 57s. Volume1, Issue1January 1955Pages 14-14 RelatedInformation

The development of body fluid physiology and fluid therapy in pediatrics has special importance in the history of medicine because this development introduced physiology into clinical practice. James Gamble and Dan Darrow were leaders in this enterprise. Gamble was part of the group John Howland attracted to Johns Hopkins to establish the first organized program for clinical investigators in pediatrics. This group initiated fluid therapy as effective treatment for diarrheal dehydration and, led by Gamble, developed the discipline of body fluid physiology. Gamble was the first to describe the nature of extracellular fluid (ECF) to clinicians, using the new terminology for characterizing electrolytes in solution. In doing so, he became the teacher of body fluid physiology to a generation of medical students. Inexplicably, in his later years he failed to adopt yet newer terminology defining cations, anions, and acid-base status. This failure compromised his legacy. Dan Darrow extended our understanding of how body fluids react to hyper- and hyponatremia and to potassium deficiency. He was the first to add potassium to parenteral fluid therapy. In doing so, he broadened clinicians' understanding of body fluids but changed the emphasis of fluid therapy from rapid ECF restoration to replacement of estimated deficits. Unfortunately, this change in concept, taught by his successors as deficit therapy, slowed the adoption of oral rehydration therapy for treating diarrheal dehydration. The lapses noted for each of these men, now seen in hindsight, pale in comparison to their contributions. Pediatrics, medicine, and surgery are all indebted to the research of each, which emphasized the value of basic physiology in clinical practice.

Paediatric fluid therapy is a complex area. The unique physiology of paediatric patients presents a number of challenges that must be accounted for in prescribing fluid therapy. Paediatric fluid therapy was historically based on Holliday and Segar’s 1957 paper. However, recent evidence has advocated moving away from the hypotonic fluid recipe that was the go-to fluid therapy for maintenance fluids in children. Instead, balanced isotonic crystalloids have come into favour. This particularly reduces the risk of hyponatraemia that was commonly seen in post-op surgical patients due to non-physiologic anti-diuretic hormone release. Moreover, the perceived requirement for glucose administration to prevent hypoglycaemia may have been overstated and it is necessary only in selected patients. Colloids have yet to be shown to be superior to crystalloids, except for the selected use of albumin in patients who are vulnerable to fluid overload. Recently, there has been considerable interest in combining the above findings into an ‘ideal’ fluid but, as yet, that has not happened and the onus is on the prescribing clinician to understand and account for the relative benefits and potential harms of their fluid prescriptions.

Background:Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists. Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital.Methods:After obtaining approval from the Departmental Research Review Committee, a survey form including questions was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed.Results:Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in this survey. Majority of anesthesiologist have used, 1/2 dextrose saline (52.7%) as fluid of choice in routine intraoperative maintenance, while Hartmann's solution (41.8%) and normal saline 0.9% (5.5%) were used for rest of the them. The Holliday-Segar method for maintenance fluid was mentioned by 92.7% of anesthesiologists.Conclusion:The use of hypotonic fluid in perioperative care in pediatric population is still being practiced despite the current guidelines. These results point to a considerable gap between the available evidence and practice.

The anesthesia of pediatric surgery has some special features.Pediatric body fluid has higher proportion than that of adult patients and higher exchange rate.Insufficient transfusion may lead to dehydration,shock,etc,while over transfusion could lead to heart failure,lung edema,etc.Therefore,establishing criteria for appropriate operative transfusion is important to ensure safety during operation and postoperative recovery.In this article,we discussed the perioperative fluid therapy in pediatrics.

Water content, percentage of total body water lost as a function of time, and cuticular permeability are determined for 10 species of millipedes representing three orders (Polydesmida, Spirobolida and Spirostreptida). Mean water content per cubic centimeter of body mass ranges from 422 mg for Polydesmopeltis kelaarti to 886 mg for yet undetermined Species B (Spirostreptida: Harpagophoridae). Mean percentage of total body water ranged from 57.46 for Orthomorpha coarctata to 70.21 for P. kelaarti. Mean cuticular permeability ranges from 20.28 μg cm-1h-1mm Hg-1 for Gonoplectus malayusto 82.53 μg cm-1h-1mm Hg- 1for O.coarctata. Cumulative percentage of total body water lost at 20 hour varied widely ranging from 9.35% in G. malayus to 61.64% in O. coarctata. Smaller millipedes (Polydesmida), having lower water reserve, higher CP values and higher rate of percent of TBW lost, are less tolerant to desiccation compared with larger species (Spirobolida and Spirostreptida). Analyzed polydesmids are restricted to hygric environments, whereas, spirobolids and spirostreptids can tolerate desiccation to a large extent and are confined to mesic or xeric habitats.

Perioperative fluid therapy should be considered as a medical prescription of which both the volume and the composition should be adapted to the patient status, the type of operation and the expected events in the postoperative period. Perioperative fluid therapy is aimed at providing maintenance fluid requirements, at correcting fluid deficit and at providing the volume of fluid needed to maintain adequate tissues perfusion. Recent literature is challenging the old concepts for maintenance fluid requirements described by Holliday and Segar in 1957(1), and the recommendations regarding both volume and content of perioperative solutions have been the subject of recent controversies. Fluid therapy in the neonatal period will not be considered in the present lecture.

Purpose. The aim of the study was to examine the effects of five weeks detraining period on body composition changes in elite professional Indonesian male soccer players. Material and methods. The body composition of 24 top-level male soccer players (age: 26.33 ± 4.06 years) competing in First League of Indonesia was measured before and after the 5-weeks detraining period. Body composition variables, including body mass, body fat percentage, fat-free mass, and total body water percentage, were measured using the bioelectrical impedance method. The results. The paired samples T-test showed significant changes in the means of body composition variables for body fat percentage, fat-free mass, and total body water percentage. Mean values for body fat percentage increased during the detraining period from 10.87 ± 2.47% to 11.98 ± 2.75% (10.3%). A decrease in mean values for fat-free mass (61.34 ± 5.74 kg to 59.80 ± 6.22; 2.49%) and total body water percentage (from 65.13 ± 1.84% to 64.40 ± 1.99%; 1.12%) was observed. No significant changes occurred in body mass (from 69.05 ± 8.07 kg to 69.05 ± 8.48 kg; 0.04%) from initial to final testing. Conclusions. Since there was a significant difference in body fat percentage, fat-free mass, and total body water percentage% before and after detraining period., it is suggested that 5 weeks of detraining period. for the professional soccer players may not be necessary, and the duration should be shortened to maintain body composition status.

Perioperative fluid, electrolyte and blood transfusion therapy for infants and children can be confusing due the numerous opinions, formulas and clinical applications, which can result in a picture that is not practical and is often misleading. Perioperatively, crystalloids, colloids and blood components are required to meet the ongoing losses and for maintaining cardiovascular stability to sustain adequate tissue perfusion. Recently controversies have been raised regarding historically used formulas and practices of glucose containing hypotonic maintenance crystalloid solutions for perioperative fluid therapy in children. Paediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss ≥ one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. A meticulous fluid, electrolyte and blood transfusion management is required in paediatric patients perioperatively because of an extremely limited margin for error. This article reviews the basic concepts in perioperative fluid and blood transfusion therapy for paediatric patients, along with recent recommendations. For this review, Pubmed, Ovid MEDLINE, HINARI and Google scholar were searched without date restrictions. Search terms included the following in various combinations: Perioperative, fluid therapy, paediatrics, blood transfusion, electrolyte disturbances and guidelines. Only articles with English translation were used.

Background: Malnutrition can have reversible effects on patients with chronic kidney disease (CKD). Patients with CKD are exposed to a wasting syndrome, because of disorders of nutrient absorption, excretion, and other factors. Aim: The aim is to identify changes in body fat percent (BFP), lean body mass (LBM), and total body water (TBW) percentage in patients with CKD using bioelectrical impedance analysis (BIA). Setting and Design: This study was conducted in 438 CKD patients (212 males and 226 females) attending a Nephrology Clinic in a Tertiary Level University hospital from 2008 to 2014, who were followed up for 6 months. Materials and Methods: The anthropometric and BIA data of all patients, who consented to participate, was collected and analyzed for LBM, BFP, and percentage of TBW. Results: Correlation coefficient of body mass index (BMI) and glomerular filtration rate is 0.20 and 0.227 in men and women in 0 week (baseline), respectively. In 24 weeks (endpoint), that is, 0.526 and 0688. In male patients, the average value of BFP was decreased 0.9%–1.4%, the average LBM was decreased 0.5–1.3 (kg/m, height), and then the average percentage of TBW was increased 0.3%–0.9% after G3 stage. In one side, in female patients, BFP was increased 0.3%–2.9%, the LBM was decreased 0.4–0.7 (kg/m, height), and then average percentage of TBW was increased 0.2%–0.8% after G3 stage. Collectively, BMI, LBM, and BFP were decreased according to CKD stage, in contrast with this, TBW percentage was increased. Discussion: These results suggest that protein-energy malnutrition is the main factor related to malnutrition in patients with CKD. The LBM and BFP were decreased, and percentage of TBW was increased in CKD.

This book successfully combines basic physiology of water and electrolyte metabolism with applicable schedules of fluid therapy. It can be divided into three sections. The first 30 pages discuss principles of water, electrolyte and acid-base balance including basic differences in fluid compartment size, turnover and components in infants, children, and adults. The acid-base section includes a discussion of buffers, the use of the Astrup method, examples of classical problems and the usual indications and precautions observed when treating patients with bicarbonate or THAM buffer. Unfortunately not even simple renal physiology is included. Maintenance requirements including nutritionally complete parenteral feeding are summarized. The bulk of the text deals with treatment situations. Following definition of the problem, each section contains a brief discussion of pathophysiology, clinical and laboratory features, and treatment. Chapters that are especially informative are those considering iso-, hypo- and hypertonic dehydration and neonatal problems. Other subjects discussed

Aim: To investigate the effect of hemodialysis on blood pressure by monitoring ambulatory blood pressure during the interdialysis period and to evaluate the relationship between hypertension and the percentage of total body water calculated via bioelectrical impedance analysis. Methods: Twenty five patients with end stage renal disease who were in the hemodialysis program were included in the study. But only fifteen patients had been able to stay in the required criteria till the end. Pre- and post-dialysis blood pressures of the patients were measured manually and ambulatory blood pressure measurements were obtained during the interdialysis period. Measurements of total body water were performed with bioelectrical impedance method following the hemodialysis procedure. The patients were evaluated for daily course of blood pressure, use of anti-hypertensive medications, incidence of the falling rate of blood pressure at night, amount of total body water and interdialysis weight gain. Results: Manual pre- and post-dialysis measurements and mean values of 44 hours’ ambulatory blood pressure monitoring were found to be similar. Blood pressures were found to be significantly low until the 24th hour and they were increased at the 2nd day, then returned to initial levels at the 44th hour. There was uncontrolled hypertension in 7 of the 11 hypertensive patients (63.6 %). Mean percentage of total body water was higher in patients with hypertension (61.1 ±9.8 vs. 57.9±7.0, p>0.05). Conclusion: In our study, the reducing effect of hemodialysis on blood pressure was observed and this effect has continued nearly 24 hours after the dialysis. The fact that total body water is more in hypertensive patients supports the idea that volume excess is an important factor responsible from hypertension.