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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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LETTER TO EDITOR
Year : 2010  |  Volume : 15  |  Issue : 2  |  Page : 76-77
 

A nonrandomized interventional study on perioperative fluid in children


1 Department of Pediatric Surgery, PSG Institute of Medical Science and Research, Coimbatore, Tamilnadu, India
2 Department of Community Medicine, PSG Institute of Medical Science and Research, Coimbatore, Tamilnadu, India

Date of Web Publication24-Sep-2010

Correspondence Address:
Cenita J Sam
Department of Pediatric Surgery, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.70652

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How to cite this article:
Sam CJ, Arunachalam P, Sivamani M. A nonrandomized interventional study on perioperative fluid in children. J Indian Assoc Pediatr Surg 2010;15:76-7

How to cite this URL:
Sam CJ, Arunachalam P, Sivamani M. A nonrandomized interventional study on perioperative fluid in children. J Indian Assoc Pediatr Surg [serial online] 2010 [cited 2019 Nov 13];15:76-7. Available from: http://www.jiaps.com/text.asp?2010/15/2/76/70652


Sir,

There have been reports of postoperative deaths due to hyponatremia in children after surgery, such as tonsillectomy, orchiopexy and appendectomy. All these children had received hypotonic fluids such as Isolyte P. [1],[2] Following these reports, the National Patient Safety Alert was issued in 2007 by NHS. [3] Because of the secretion of ADH in the perioperative period, isotonic fluids should be administered and may have to be reduced to two-third the requirement when they are very sick. [2],[3],[4]

Administration of dextrose was thought to be mandatory as it was difficult to detect hypoglycemia in an anesthetized child. [4] But, hyperglycemia causes osmotic diuresis, dehydration and electrolye imbalance. The danger of hyperglycemia in the perioperative period is a real clinical issue that has been extensively reviewed. [5]

We have conducted a prospective, nonrandomized study after obtaining approval from the ethical committee. The aim of the study was to estimate the postoperative sugar levels after administering 5% sugar/sugar-free fluid and to note the incidence of hypoglycemia and hyperglycemia. Children undergoing surgery were enrolled and were divided into two groups. Group I received sugar-containing fluids (5% sugar) and Group II received sugar-free fluids (RL or NS). Fasting was as per the ASA guidelines and fluid was started at the time of surgery. In Group I, the blood sugar level was estimated 4 h after surgery. In Group II, the blood sugar level was estimated immediately after surgery and again after 4 h. Serum sodium was estimated after 4 h in Group II.

Twenty-nine patients were enrolled in Group I and 39 patients in Group II. The mean sugar level was 121.03 ± 34.11 mg/dl in Group I and 107.33 ± 17.42 mg/dl in Group II at 4 h, P value = 0.054. Eight patients (27.5%) developed hyperglycemia, with a mean value of 166.88 ± 32.53 mg/dl in Group I and six patients (15.38%) had hyperglycemia, with a mean value of 135.16 ± 5.07 mg/dl in Group II. The P-value was 0.028. It was seen that there was hyperglycemia (48.5% immediately after surgery and 15.38% after 4 h) even after the administration of sugar-free fluid. The level of hyperglycemia was higher after the administration of 5% sugar-containing fluid.

Group II had their sugar tested immediately after surgery as they had received sugar-free fluid, and there was no hypoglycemia. The lowest sugar level was 80 mg/dl immediately after surgery and 72 mg/dl after 4 h. Hence, administering sugar-free fluid did not cause hypoglycemia in the immediate postoperative period.

Serum sodium was estimated in Group II as RL and NS contain more than the recommended amount of sodium. The mean was 137.94 ± 1.49 mEq/L. In spite of administering an increased amount of sodium, there was no incidence of hypernatremia.

We conclude that the administration of isotonic fluids is safe in the perioperative period as it causes only mild hyperglycemia and no hypoglycemia. This is also not associated with hypernatremia. Administration of 5% sugar-containing fluids is associated with hyperglycemia.


   Acknowledgement Top


Our sincere thanks to Mr. Raja for his help with data collection.

 
   References Top

1.Moritz ML, Ayus JC. Prevention of hospital -acquired hyponatremia: A case for using isotonic saline. Pediatrics 2003;111:227-30.  Back to cited text no. 1      
2.Way C, Dhamrait R, Wade A, Walker I. Perioperative fluid therapy in children: A survey of current prescribing practice. Br J Anaesth 2006;97:371-9.  Back to cited text no. 2      
3.National patient safety agency NHS: Reducing the risk of hyponatremia when administering intravenous infusions in children. Mar 28 2007.   Back to cited text no. 3      
4.Murat I, Dubois MC. Perioperative fluid therapy in pediatrics. Pediatr Anaesth 2008;18:363-70.  Back to cited text no. 4      
5.Sieber FE, Smith DS, Traystman RJ, Wollman H. Glucose: A reevaluation of its intraoperative use. Anesthesiology 1987;67:72-81.  Back to cited text no. 5      




 

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