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APA Perioperative Fluid Management 2007

APA Perioperative Fluid Management 2007

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Published by prashsubbu
2007 guidelines for paediatric perioperative fluid management
2007 guidelines for paediatric perioperative fluid management

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Categories:Types, Research
Published by: prashsubbu on Nov 01, 2010
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12/28/2012

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APA CONSENSUS GUIDELINE ON PERIOPERATIVE FLUID MANAGEMENT INCHILDREN v 1.1 September 2007 © APAGBI Review Date August 2010Please feedback comments tomary.cunliffe@rlc.nhs.uk  
CONSENSUS GUIDELINEONPERIOPERATIVEFLUID MANAGEMENT INCHILDREN2007
 
APA CONSENSUS GUIDELINE ON PERIOPERATIVE FLUID MANAGEMENT INCHILDREN v 1.1 September 2007 © APAGBI Review Date August 2010Please feedback comments tomary.cunliffe@rlc.nhs.uk  
Table of Contents
Table of Contents..............................................................................................................2EXECUTIVE SUMMARY...................................................................................................3INTRODUCTION............................................................................................................4METHODS.......................................................................................................................4LIST OF PARTICIPANTS...............................................................................................5EXTENDED GROUP included.........................................................................................61.1 STATEMENT OF INTENT....................................................................................71.2 SCOPE OF THE GUIDELINE................................................................................72 ORAL FLUID MANAGEMENT PRIOR TO SURGERY..........................................83 ASSESSMENT AND CORRECTION OF ANY FLUID DEFICIT............................94 MAINTENANCE FLUID REQUIREMENTS IN CHILDREN................................115 FLUID AND DEXTROSE MANAGEMENT DURING SURGERY........................136 MANAGEMENT OF OTHER LOSSES DURING SURGERY................................147 POST OPERATIVE FLUID MANAGEMENT........................................................158 MONITORING OF FLUID THERAPY...................................................................169 MANAGEMENT OF HYPONATRAEMIA.............................................................1710 MANAGEMENT OF HYPERNATRAEMIA.........................................................1811 MANAGEMENT OF POTASSIUM IMBALANCE...............................................1912 MANAGEMENT OF CALCIUM IMBALANCE...................................................20Clinical Scenarios...........................................................................................................21Clinical Scenario 1: Peri-operative hyponatraemia.......................................................21Clinical Scenario 2: Per-operative management of diabetes insipidus..........................22Clinical Scenario 3: Pyloric stenosis............................................................................25Clinical Scenario 4: The day case with prolonged starvation period.............................26REFERENCES...................................................................................................................28Appendix 1 – SEARCH TERMS........................................................................................32Appendix 2 – SOURCE DOCUMENTS.............................................................................37
 
APA CONSENSUS GUIDELINE ON PERIOPERATIVE FLUID MANAGEMENT INCHILDREN v 1.1 September 2007 © APAGBI Review Date August 2010Please feedback comments tomary.cunliffe@rlc.nhs.uk  
EXECUTIVE SUMMARY
1.
 
Children can safely be allowed clear fluids 2 hours before surgery withoutincreasing the risk of aspiration.2.
 
Food should normally be withheld for 6 hours prior to surgery in children aged 6months or older.3.
 
In children under 6 months of age it is probably safe to allow a breast milk feedup to 4 hours before surgery4.
 
Dehydration without signs of hypovolaemia should be corrected slowly.5.
 
Hypovolaemia should be corrected rapidly to maintain cardiac output and organperfusion.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 SegarBody weight Daily fluid requirement0-10kg 4ml/kg/hr10-20kg 40ml/hr + 2ml/kg/hr above 10kg>20kg 60ml/hr + 1ml/kg/hr above 20kg8.
 
A fluid management plan for any child should address 3 key issuesi.
 
any fluid deficit which is presentii.
 
maintenance fluid requirementsiii.
 
any losses due to surgery e.g. blood loss, 3
rd
space losses9.
 
During surgery all of these requirements should be managed by giving isotonicfluid in all children over 1 month of age10.
 
The majority of children over 1 month of age will maintain a normal blood sugarif given non-dextrose containing fluid during surgery11.
 
Children at risk of hypoglycaemia if non-dextrose containing fluid is given arethose on parenteral nutrition or a dextrose containing solution prior to theatre,children of low body weight (<3
rd
centile) or having surgery of more than 3 hoursduration and children having extensive regional anaesthesia. These children atrisk should be given dextrose containing solutions or have their blood glucosemonitored 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 withcyanotic congenital heart disease and neonates may need a higher haematocrit tomaintain oxygenation.13.
 
Fluid therapy should be monitored by daily electrolyte estimation, use of a fluidinput/output chart and daily weighing if feasible.14.
 
Acute dilutional hyponatraemia is a medical emergency and should be managedin PICU.

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