Pediatric perioperative fluid management.

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Korean Journal of Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-04-19 DOI:10.4097/kja.23128
Hyungmook Lee, Jin Tae Kim
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Abstract

The purpose of perioperative fluid management in children is to maintain adequate volume status, electrolyte level, and endocrine system homeostasis during the perioperative period. Although hypotonic solutions containing glucose have traditionally been used as pediatric maintenance fluids, recent studies have shown that isotonic balanced crystalloid solutions lower the risk of hyponatremia and metabolic acidosis perioperatively. Isotonic balanced solutions have been found to exhibit safer and more physiologically appropriate characteristics for perioperative fluid maintenance and replacement. Additionally, adding 1-2.5% glucose to the maintenance fluid can help prevent children from developing hypoglycemia as well as lipid mobilization, ketosis, and hyperglycemia. The fasting time should be as short as possible without compromising safety; recent guidelines have recommended that the duration of clear fluid fasting be reduced to 1 h. The ongoing loss of fluid and blood as well as the free water retention induced by antidiuretic hormone secretion are unique characteristics of postoperative fluid management that must be considered. Reducing the infusion rate of the isotonic balanced solution may be necessary to avoid dilutional hyponatremia during the postoperative period. In summary, perioperative fluid management in pediatric patients requires careful attention because of the limited reserve capacity in this population. Isotonic balanced solutions appear to be the safest and most beneficial choice for most pediatric patients, considering their physiology and safety concerns.

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儿科围手术期液体管理。
儿童围手术期液体管理的目的是在围手术期维持足够的容积状态、电解质水平和内分泌系统的稳态。虽然含有葡萄糖的低渗溶液传统上被用作儿科维持液,但最近的研究表明,等渗平衡晶体溶液可降低围手术期低钠血症和代谢性酸中毒的风险。等渗平衡溶液被发现在围手术期液体维持和替换中表现出更安全和更生理上合适的特性。此外,在维持液中添加1-2.5%的葡萄糖有助于防止儿童发生低血糖、脂质动员、酮症和高血糖。禁食时间应尽可能短,但不影响安全;最近的指南建议将清液禁食时间缩短至1小时。持续的液体和血液流失以及由抗利尿激素分泌引起的游离水潴留是术后液体管理的独特特征,必须加以考虑。降低等渗平衡溶液的输注速率可能是必要的,以避免术后稀释性低钠血症。总之,由于儿科患者的储备能力有限,围手术期的液体管理需要特别注意。考虑到他们的生理和安全问题,等渗平衡溶液似乎是大多数儿科患者最安全和最有益的选择。
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来源期刊
CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
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