Abstract
In pediatric fluid therapy it would be preferable to describe distribution and elimination a fluid bolus based on repetitive hemoglobin (Hb) according to kinetic principles. Pulse CO-Oximetry is a recent advancement in patient monitoring that allows for the continuous noninvasive measurement of Hb (SpHb). The aim of this study was to describe the distribution and elimination of hydroxyethylstarch (HES) 130/0.4 in combination with crystalloids using a noninvasive Hb monitor in two cohorts of young children undergoing minor surgeries under general anesthesia. Two cohorts, 16 children aged 1–3 years and 12 aged 4–6 years, were investigated during anesthesia and minor surgical procedures. They were given a maintenance solution of lactated Ringer’s and a fluid bolus of HES 130/0.4, 6 mL/kg over a period of 20 min. The whole procedure lasted 120 min, and SpHb values were measured every 10 min. The SpHb values were used to calculate plasma dilution, net volume, and mean residence time (MRT) of the infused fluid. A total of 377 measured SpHbs generated individual dilution plots that showed variability, particularly for the older cohort. Distribution and elimination rates of the infused fluid were calculated. Mean dilution plots were generated. There were no significant differences in dilution, net volume or MRT between groups. A non invasive Hb analyzer could be used to calculate fluid distribution. The variability in the data can probably be explained by reactions to anesthetic drugs, variability in measurement technique, variability in generating the complex capillary signals, and individual variability in baseline fluid status. The latter finding is important because this is a prerequisite for perioperative fluid planning for each individual.
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Acknowledgments
Authors recieved Funding from Department of Health, Zhejiang Province, WKJ2010-2-017 to Qingquan Lian and 2012RCA044 to Ruifeng Zeng; Department of Science and Technology, Zhejiang Province, 2011C33042 to Wangning Shangguan; Fund for Natural Science, Zhejiang Province, Y2110380 to Huacheng Liu. This manuscript was screened for plagiarism using http://www.dustball.com/cs/plagiarism.checker.
Ethical standard
An ethical permit (#2011–10) was issued by the Second Hospital & Yuying Children’s Hospital of Wenzhou Medical College Research Ethics Committee. This study was conducted with written informed consent from the parents of the study subjects. The experiments performed in this study comply with the laws of the People′s Republic of China.
Conflict of interest
Christer Svensen consulted for Masimo Inc. and received research funding from Masimo Inc. He served in 2009 as an adviser at a scientific meeting for Masimo in Milan, Italy, during the ESA for which he received an honorarium.
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Lian, Q., Li, H., Zeng, R. et al. The use of a noninvasive hemoglobin monitor for determining fluid distribution and elimination in pediatric patients undergoing minor surgery. J Clin Monit Comput 29, 41–46 (2015). https://doi.org/10.1007/s10877-014-9566-6
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DOI: https://doi.org/10.1007/s10877-014-9566-6