Intraoperative fluid management in children - a comparison of three fluid regimens.

Background: Fluid therapy is essential for safe perioperative management. Numerous reports of serious complications, including brain damage and death of children, as a result of inappropriate fluid management, have been published. The aim of this study was to assess the effects of intraoperative fluids on serum glucose and electrolytes 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 induction of anaesthesia, immediately after completion of surgery and 60 min later. 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 hyponatremia occurred in the group RA. Postoperative osmolality decreased significantly in groups G5W and GNaCl and remained unchanged in the group RA. Conclusions: Ringer’s acetate did not cause significant changes in glucose and electrolyte concentrations, so it seems to be the safest for intraoperative use in children undergoing elective surgery. Hypotonic fluids may cause hyperglycaemia and hyponatraemia so they should be avoided intraoperatively.