European consensus statement for intraoperative fluid therapy in children

Sümpelmann, Robert; Becke, Karin; Crean, Peter; Jöhr, Martin; Lönnqvist, Per‐Arne; Strauß, J.; Veyckemans, Francis

doi:10.1097/eja.0b013e3283446bb8

Cited by 94 publications

(59 citation statements)

References 20 publications

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“…Acute hyponatraemia can cause brain oedema and lead to its permanent damage or even death. Despite the British consensus guidelines on perioperative fluid management in children published in 2007 [4] and the European guidelines of 2011 [5,6], new reports are still emerging. This shows a lack of awareness that administration of hypotonic fluids perioperatively is unacceptable in children [7].…”

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confidence: 99%

Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Mierzewska-Schmidt¹

2015

Anaesthesiol Intensive Ther

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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.

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confidence: 99%

Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Mierzewska-Schmidt¹

2015

Anaesthesiol Intensive Ther

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“…An ideal intraoperative fluid should have a tonicity and sodium concentration close to the physiologic range [94] . To avoid lipolysis, hypoglycemia, or hyperglycemia, 1.0%-2.5% glucose (rather than 5%) should be used and should also include metabolic anions (i.e., acetate, lactate or malate) as bicarbonate precursors to prevent hyperchloremic acidosis.…”

Section: Resultsmentioning

confidence: 99%

Impact of perioperative hyponatremia in children: A narrative review

Andersen

Afshari

2014

WJCCM

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For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body's primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children. Key words: Children; Fluid; Hyponatremia; Pediatric; Perioperative Core tip: Hospital-acquired hyponatremia is common, particularly among children undergoing surgery. These children tend to develop hyponatremic encephalopathy at higher serum sodium concentrations than adults and they have a poorer prognosis. As the risk is increased by the use of hypotonic fluids, intraoperative fluids for children should be isotonic. Symptomatic hyponatremia should be corrected with 3% sodium chloride and close monitoring of the patient and serum sodium level is mandatory to prevent brain herniation and neurologic damage from cerebral ischemia.Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med 2014; 3(4): 95-101 Available from:

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“…Pada kondisi risiko tinggi hipoglikemia dekstrosa diberikan dengan kadar minimal, yaitu 1 atau 2% karena glukosa yang lebih tinggi dapat menyebabkan terjadinya hiperglikemia dan gangguan elektrolit intraoperatif. [19][20][21] Pada penelitian ini hampir seluruh subyek mendapat kristaloid yang mengandung asetat atau campuran asetat dan malat. Cairan kristaloid yang mengandung anion metabolik (asetat, laktat, malat) sebagai prekursor bikarbonat dapat mencegah terjadinya asidosis hiperkloremik, di sisi lain beberapa penelitian menunjukkan adanya peningkatan kadar laktat dalam darah pada populasi yang mendapat cairan dengan buffer laktat.…”

Section: Pembahasanunclassified

Hiponatremia pada Anak Pasca Tindakan Operasi : Etiologi dan Faktor-faktor yang Berhubungan

Arifin¹,

Pudjiadi²,

Handryastuti³

et al. 2017

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Latar belakang. Kejadian hiponatremia pada anak pasca-operasi berkisar antara 20-40%. Hiponatremia yang tidak terdeteksi dapat meningkatkan mortalitas dan menyebabkan luaran neurologis yang buruk. Beberapa mekanisme yang berperan adalah sindrom hormon antidiuretik tidak tepat (SHATT) dan sick cell syndrome (SCS). Tujuan. Mengetahui insidens hiponatremia pada anak pasca-operasi, kemungkinan penyebab yang melatarbelakangi, serta faktor yang berhubungan. Metode. Penelitian potong lintang analitik dilakukan di ruang perawatan intensif terhadap anak berusia 1 bulan sampai 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif pediatrik RSCM selama bulan Mei sampai Desember 2016. Hasil. Terdapat 65 subyek menjalani operasi mayor, 87,69% dilakukan secara elektif, jenis operasi terbanyak adalah hepatogastrointestinal (38,46%) dan muskuloskeletal (20,00%). Kadar natrium plasma pasca-operasi turun, kejadian hiponatremia 43,07% dan 26,16% pada 12 dan 24 jam pasca-operasi. Nilai osmolalitas plasma yang normal atau meningkat dan osmolalitas urin >100 mOsm/kg. Sebanyak 70% subyek hiponatremia memiliki natrium urin >30 mEq/L. Faktor yang berhubungan dengan hiponatremia 12 jam pasca-operasi adalah status kegawatdaruratan operasi (p=0,007) dan perdarahan intraoperatif (p=0,024), sedangkan pada 24 jam pasca-operasi hanya status kegawatdaruratan operasi (p=0,001). Kesimpulan. Terdapat 43,07% dan 26,16% subyek yang mengalami hiponatremia pada 12 dan 24 jam pasca-operasi mayor. Sindrom hormon antidiuretik tidak tepat tidak terbukti menjadi penyebab utama terjadinya hiponatremia, dan hiponatremia translokasional pada SCS mungkin berperan. Hiponatremia pasca-operasi berhubungan dengan status kegawatdaruratan operasi dan jumlah perdarahan intraoperatif. Sari Pediatri 2017;19(2):63-70Kata kunci: hiponatremia, pasca-operasi, hormon antidiuretik, sick cell sydrome Hyponatremia in Post-surgery Pediatric Patients: Etiology and Its Related FactorsAngelina, Antonius H. Pudjiadi, Setyo Handryastuti, Idham Amir, Evita B. Ifran, Mulya R. KaryantiBackground. The incidence of hyponatremia in post-surgery pediatric patients is 20-40%. Undetected hyponatremia correlates with higher mortality and poor neurology outcomes. There are several mechanisms in post-surgery hyponatremia, such as syndrome of inappropriate antidiuretic hormone and sick cell syndrome. Objective. To establish the incidence of hyponatremia among post-surgery pediatric patients, possible etiologies, and its related factors. Method. Observational analytic study was conducted forchildren aged 1 month until 18 years old after underwent major surgery in CM hospital pediatric intensive care unit, between May and December 2016. Results. There were 65 subjects underwent mayor surgery, mostly (87.69%) were elective surgery. The most common surgeries were hepato-gastrointestinal (38,46%) and musculoskeletal (20,00%) surgery. There was significant reductionof plasma natrium after surgery, with hyponatremia incidence at 12 and 24 hours post-surgery were 43.07% and 2...

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European consensus statement for intraoperative fluid therapy in children

Cited by 94 publications

References 20 publications

Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Płynoterapia śródoperacyjna w praktyce pediatrycznej — porównanie wybranych płynów infuzyjnych

Impact of perioperative hyponatremia in children: A narrative review

Hiponatremia pada Anak Pasca Tindakan Operasi : Etiologi dan Faktor-faktor yang Berhubungan

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