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Fluid Management in Children Undergoing Surgery and Anesthesia

  • Ric BergesioEmail author
  • Marlene Johnson
Chapter

Abstract

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.

Keywords

Preoperative fasting Blood transfusion in children Pediatric intravenous fluids Pediatric fluid management Massive transfusion in children Critical bleeding in children Transfusion trigger in children 

Further Reading

Fasting

  1. Andersson H, Schmitz A, Frykholm P. Preoperative fasting guidelines in pediatric anesthesia: are we ready for a change? Curr Opin Anesthesiol. 2018;31:342–8.CrossRefGoogle Scholar
  2. Association of Paediatric Anaesthesia. APA Consensus Statement on updated fluid fasting guidelines for children prior to elective general anaesthesia 2018. www.apagbi.org.uk.
  3. Frykholm P, et al. Preoperative fasting in children: review of existing guidelines and recent developments. Br J Anaesth. 2018;120:469–74.CrossRefGoogle Scholar
  4. Thomas M, et al. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Pediatr Anesth. 2018;28:411–4.CrossRefGoogle Scholar

IV Fluids

  1. Arumainathan R, Stendall C, Visram A. Management of fluids in neonatal surgery. BJA Educ. 2018;18:199–203.CrossRefGoogle Scholar
  2. Association of Paediatric Anaesthesia. APA consensus guideline on perioperative fluid management in children 2007. www.apagbi.org.uk.
  3. Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg. 2010;110(2):375–90.CrossRefGoogle Scholar
  4. Feld LG, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142:e20183083.CrossRefGoogle Scholar
  5. McNab S, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014;(12):CD009457.Google Scholar
  6. National Institute for Health and Care Excellence. Intravenous fluid therapy in children and young people in hospital: NICE guideline 2015. www.nice.org.uk/guidance/ng29. Accessed July 2019.
  7. Saudan S. Is the use of colloids for fluid replacement harmless in children? Curr Opin Anesthesiol. 2010;23:363–7.CrossRefGoogle Scholar
  8. Sumpelmann R, et al. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Pediatr Anesth. 2017;27:10–8.CrossRefGoogle Scholar

Blood Transfusion

  1. Blain S, Paterson N. Paediatric massive transfusion. BJA Educ. 2016;16:269–75.CrossRefGoogle Scholar
  2. Clebone A. Pediatric trauma transfusion and cognitive aids. Curr Opin Anesthesiol. 2018;31:201–6. Reviews damage control resuscitation in children and how outcomes differ from adults, as wells as studies of antifibrinolytics and new factor therapies in children.Google Scholar
  3. Patient Blood Management Guidelines Module 6 Neonatal and Pediatrics: National Blood Authority 2016. https://www.blood.gov.au/pbm-module-6. Accessed July 2019.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anaesthesia and Pain ManagementPerth Children’s HospitalNedlandsAustralia

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