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Thursday, September 24, 2009

Paediatric perioperative fluid management

http://www.rcoa.ac.uk/apagbi/docs/Perioperative_Fluid_Management_2007.pdf

EXECUTIVE SUMMARYAPA CONSENSUS GUIDELINE ON PERIOPERATIVE FLUID MANAGEMENT IN CHILDREN v 1.1 September 2007 © APAGBI Review Date August 2010
1. Children can safely be allowed clear fluids 2 hours before surgery without
increasing the risk of aspiration.
2. Food should normally be withheld for 6 hours prior to surgery in children aged 6
months or older.
3. In children under 6 months of age it is probably safe to allow a breast milk feed
up to 4 hours before surgery
4. Dehydration without signs of hypovolaemia should be corrected slowly.
5. Hypovolaemia should be corrected rapidly to maintain cardiac output and organ
perfusion.
6. In the child, a fall in blood pressure is a late sign of hypovolaemia.
7. Maintenance fluid requirements should be calculated using the formula of
Holliday and Segar
Body weight Daily fluid requirement
0-10kg 4ml/kg/hr
10-20kg 40ml/hr + 2ml/kg/hr above 10kg
>20kg 60ml/hr + 1ml/kg/hr above 20kg
8. A fluid management plan for any child should address 3 key issues
i. any fluid deficit which is present
ii. maintenance fluid requirements
iii. any losses due to surgery e.g. blood loss, 3rd space losses
9. During surgery all of these requirements should be managed by giving isotonic
fluid in all children over 1 month of age
10. The majority of children over 1 month of age will maintain a normal blood sugar
if given non-dextrose containing fluid during surgery
11. Children at risk of hypoglycaemia if non-dextrose containing fluid is given are
those on parenteral nutrition or a dextrose containing solution prior to theatre,
children of low body weight (<3rd centile) or having surgery of more than 3 hours
duration and children having extensive regional anaesthesia. These children at
risk should be given dextrose containing solutions or have their blood glucose
monitored during surgery.
12. Blood loss during surgery should be replaced initially with crystalloid or colloid,
and then with blood once the haematocrit has fallen to 25%. Children with
cyanotic congenital heart disease and neonates may need a higher haematocrit to
maintain oxygenation.
13. Fluid therapy should be monitored by daily electrolyte estimation, use of a fluid
input/output chart and daily weighing if feasible.
14. Acute dilutional hyponatraemia is a medical emergency and should be managed
in PICU.