Perioperative infusions in paediatric patients: rationale for using Ringer-lactate solution with low dextrose concentration

Abstract

To assess the usefulness of Ringer-lactate solution with 0.9% dextrose, fluid therapy during surgery in paediatric patients was reviewed. From the literature, the need for intravenous (i.v.) infusion and water could be established. The need for sodium was also evident and use of normonatraemic i.v. solutions should be recommended to avoid hyponatraemia. Little data were found about the value of the other electrolytes. Dextrose requirements have been the subject of debate for the last two decades. The choice of dextrose concentration is a compromise between avoiding hypoglycaemia and hyperglycaemia. Four clinical trials assessing the use of Ringer-lactate solution with 0.9 or 1% dextrose in paediatric patients suggest that it is appropriate for routine infusion in paediatric patients during the perioperative period. However, fluid therapy during surgery has rarely been studied, probably because it is inexpensive, rarely leads to problems and is used in very different clinical settings. Development of consensus clinical guidelines on the use of electrolyte infusions in paediatric surgery would be helpful.

A novel isotonic-balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post-authorization safety study (PASS)

“…It is a well‐known fact that a lack of glucose supply enhances lipolysis leading to ketogenesis. This is not automatically accompanied by hypoglycemia (21–24). In this context, our study shows firstly that the incidence of hypoglycemia prior to induction of anesthesia is very low (<1%) when the preoperative period of starvation is short and secondly that the intravenous infusion of 1% glucose is sufficient to maintain plasma glucose concentrations within the physiologic range and to prevent metabolic acidosis from ketoacidosis.…”

Peri operative diabetic management using subcutaneous regular insulin as sliding scale and alberti regimen of glucose insulin potassium infusion - comparative study

“…In the past 2 decades, most authors have come to support the IV route of insulin administration because it avoids the less predictable absorption of SC insulin that is exacerbated by the fluid shifts that are common in patients during the perioperative period 20,21,22 .…”

Perioperative fluid therapy in pediatrics

“…Lactated Ringer is quickly degraded into bicarbonate in the liver and behaves as a buffer. As discussed below, polyionique B66 (32) presents only minor differences from standard Ringer‐lactate solutions. Its sodium concentration is slightly lower at 120 instead of 130 mmol·l −1 .…”