Fluid Management in Children Undergoing Surgery and Anesthesia
Fasting is minimized in children to reduce anxiety and irritability as well as physiologic and metabolic derangements. Fasting times have been shortened in children to 6 h for solids, 4 h for formula milk, and 1 h for clear fluids. Fasting from breast milk for 3 h is acceptable, although this may vary between centers. Neonates have low glucose stores and are at risk of hypoglycemia during fasting. It can be difficult to quantify the degree of dehydration in children, and emphasis has instead shifted to detecting ‘red flags’ warning of serious dehydration or shock. Hyponatremia is a risk of hypotonic, glucose-containing intravenous fluids, and now isotonic fluids are standard for children. Fluid therapy for neonates continues with high-glucose, low-sodium fluids because of their predisposition to hypoglycemia and poor renal concentrating ability. Blood transfusion is uncommon in children, but many recent changes in the management of critical bleeding in adults have been adapted to children.
KeywordsPreoperative fasting Blood transfusion in children Pediatric intravenous fluids Pediatric fluid management Massive transfusion in children Critical bleeding in children Transfusion trigger in children
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