Perioperative crystalloids in pediatric surgical patients: current approach

Abstract

Anesthetists are traditionally responsible for managing intraoperative fluid balance. For nearly half a century the traditional intraoperative fluid management in pediatric patients has been based on the formula by Holliday and Segar and was limited to glucose containing hypotonic fluids. There is now evidence that this results in morbidity and mortality related to a high risk of developing hyponatremia in the postoperative period. Expert opinion now favors isotonic fluids with low glucose concentration.
This editorial highlights the need for change in practice regarding both composition and volume of perioperative crystalloid fluids in children undergoing surgery, and the current recommendations on fasting, third space and postoperative fluid losses.