Abstract
The ideal intraoperative intravenous fluid in paediatric anaesthesia and surgery is still debatable. This is essential to overcome physiological changes to maintain safety and wellbeing of the patient. A new isotonic “balanced solution” (Sterofundin ® ISO) has been introduced to replace existing intraoperative fluid of choice (Ringer’s Lactate). The study aimed to observe any changes in electrolytes and acid base after infusion of each study solutions and to evaluate any post infusion electrolytes and acid base differences between both study solutions. The double blinded randomized control trial involved 141 paediatric patients who were subjected to minor surgical procedure of less than 3 hours were randomized into Ringer’s Lactate or Sterofundin ® ISO group. The electrolytes and acid base parameters were assessed at pre-infusion and post-infusion time. There were significant difference in glucose, potassium (K + ) and chloride (Cl - ) level between pre-infusion and post-infusion values with those given Ringer’s Lactate. There were also significant different in pH, base excess, glucose, Calcium (Ca 2+ ), Chloride (Cl) and lactate level between pre-infusion and post-infusion values with Sterofundin ® ISO. When comparing the mean difference (pre-infusion and post-infusion) between Ringer’s Lactate and Sterofundin ® ISO, calcium (Ca 2+ ) is the only electrtolyte which found to be significant ( P =0.015) with the values of (Means±SD 0.005±0.07) mmol/L and (Means±SD 0.02±0.06) mmol/L respectively. Both study solutions showed variable effects of electrolytes and acid base parameters and no fluid was found to be superior in paediatric surgical patients underwent minor surgery of less than three hours.
Highlights
Fluid therapy in the paediatric surgical patient is designed to provide for different fluid requirement: i.e; deficit, maintenance and ongoing loss in order to achieve adequate tissue perfusion
The maintenance of anesthesia was achieved with Isoflurane with the Minimum Alveolar Concentration (MAC) of 1 to 1.2 and mixture of oxygen and air of 30% and 70% respectively
We recruited a total of 145 paediatric patients who underwent uncomplicated elective minor surgical procedure of less than three hours duration
Summary
Fluid therapy in the paediatric surgical patient is designed to provide for different fluid requirement: i.e; deficit, maintenance and ongoing loss in order to achieve adequate tissue perfusion. Maintenance of fluid therapy in children has been based on Holiday and Segar protocol [1]. This recommendation is widely accepted and practiced in paediatric populations [2]. One group favors usage of isotonic fluid while the others defended hypotonic fluid therapy [3]. It is a matter of fact that the risk of hypoglycaemia and fluctuation of the sodium level are the most common issues addressed when dealing with type of fluid therapy in children [5]. Proper consensus should be obtained to prevent iatrogenic hyponatremia among hospitalized paediatric patients [2, 6, 7]
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