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BJA Advance Access published online on July 27, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael185
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted June 4, 2006

Clinical Investigation

Perioperative fluid therapy in children: a survey of current prescribing practice{dagger}

C. Way 1, R. Dhamrait 2, A. Wade 3, and I. Walker 4 *

1 Department of Anaesthesia, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO16 6YD, UK
2 Department of Anaesthesia, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, PO6 3LY, UK
3 Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
4 Department of Anaesthesia, Great Ormond Street Hospital NHS Trust, Great Ormond Street, London WC1N 3JH, UK

* To whom correspondence should be addressed.
I. Walker, E-mail: walkei{at}gosh.nhs.uk


  Abstract

Background. Fluid therapy in children may be associated with iatrogenic hyponatraemia. We surveyed anaesthetists’ current fluid prescribing practice during the perioperative period, departmental fluid protocols and awareness of the concerns of the Royal College of Paediatrics and Child Health (RCPCH) about the use of dextrose 4%/saline 0.18% in children.

Methods. Questionnaire survey of 477 consultant anaesthetists in two training areas in the UK.

Results. Responses were received from 289 anaesthetists (60.6%)--responses from the 203 consultants that anaesthetized children were analysed. A total of 67.7% did not have a local departmental policy for fluid prescription, and 58.1% were unaware of the concerns of RCPCH. A total of 60.1% of anaesthetists said that they prescribed hypotonic dextrose saline solutions in the intraoperative period and 75.2% did so in the postoperative period. Anaesthetists working in specialist paediatric hospitals were 5.1 times more likely to prescribe isotonic fluids intraoperatively than those working in district hospitals (95% CI 1.48-17.65, P=0.01), but they all prescribed hypotonic dextrose saline solutions postoperatively. The Holliday and Segar formula for maintenance fluid was quoted by 81.8% of anaesthetists; only 5.9% of anaesthetists would restrict fluids in the immediate postoperative period. Anaesthetists working in specialist paediatric hospitals were 13.2 times more likely to restrict fluids postoperatively than those working in district hospitals (95% CI 2.8-61.8, P=0.001).

Conclusions. The prescription of hypotonic dextrose saline solutions by anaesthetists may be putting children at risk from iatrogenic hyponatraemia. Departmental protocols for perioperative fluid prescription in children are uncommon. We suggest that national guidance is required.

Keywords: anaesthesia, paediatric; children; complications, hyponatraemia; fluid balance; fluids, hyponatraemia.
{dagger}This article is accompanied by Editorial II.
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