Intraoperative fluid management in Pediatric patients undergoing major surgery

Perioperative fluid management is extremely important among patients. While managing the pediatric patients it appears to be highly challenging as children are unable or less able to cope up with inappropriate water content and electrolyte administration compared to adults. The study provides a comparative study of the two balancing fluids which include Sterofundin ISO versus Ringers lactate. Sterofundin ISO helps in maintaining intraoperative fluid balance especially in conditions when blood becomes slightly acidic and Ringers lactate is a buffered solution most suitable in the cases of low blood pressure or low blood volume. Thus, the two solutions are evaluated in the context of major pediatric surgery. Primarily, the changes in the patient’s parameters like baseline pH, amount of fluid infused, changes in serum electrolytes, lactate level and hemodynamic fluctuations are evaluated.

In order to evaluate a randomized control trial is carried out using 27 pediatric patients who are subjected to undergo major pediatric surgery and were randomized into 2 groups maintaining 13 patients in Sterofundin ISO group and 14 patients in ringers lactate group. Baseline and hourly arterial blood gas analysis are carried out to measure pH, acid-base, lactate levels as well as electrolytes. The evaluation indicated that the use of ringer's lactate solution had more statistical significant changes in case of BE and Sodium (Na) compared to that of Sterofundin ISO. The results of the trial can be interpreted as the changes in BE and Na are more significant in the surgeries of longer duration and within larger fluid shifts, especially in the cases of hypernatremia and acidosis. Apart from this, other parameters like electrolyte profile, volume of fluid infused and BE are also found to be comparable in both the groups. Therefore, the research suggests that there has been a statistically significant difference when the parameter of pH from baseline is considered to the end of the surgery in both the groups. Further, in the surgery cases which are carried out for a longer duration and with larger fluid shifts Sterofundin ISO may have superior impact compared to ringer’s lactate in the terms of maintaining pH balance, stabilizing acid-base profile and also in reducing the risk of hypernatremia.