Anesteziyolojide Pediatrik İntraoperatif Sıvı Tedavisi

Year 2025, Volume: 34 Issue: 3, 213 - 228, 30.09.2025

Ersel Güleç

https://doi.org/10.17827/aktd.1667531

Abstract

Pediatrik anestezi, çocukların farklı fizyolojik özellikleri nedeniyle sıvı ve elektrolit yönetiminin dikkatle değerlendirilmesini gerektirir. Doğum sonrası adaptasyonların bilinmesi, dehidrasyon veya aşırı hidrasyondan kaynaklanan komplikasyonların önlenmesinde kritik öneme sahiptir. Çocukların toplam vücut suyu yüzdesi daha yüksektir, bu da onları sıvı dengesizliklerine karşı daha savunmasız hale getirir. Hissedilmeyen kayıplar solunum hızına ve çevresel koşullara bağlıdır; aksi takdirde, kayıp derhal düzeltilmezse dehidrasyona neden olur. Yenidoğan böbrek fizyolojisi sıvıların filtrasyonunu ve elektrolitlerin yönetimini etkiler, bu nedenle yenidoğanlar için bireyselleştirilmiş sıvı tedavisi gerektirir. Hormonal kontrol, kapiller hidrodinamik, metabolik faktörler ve elektrolit dengesi pediatrik sıvı tedavisini daha da karmaşık hale getirir. Yüksek teknolojili monitörizasyon ve multimodal yöntemlerle desteklenen klinik değerlendirme ölçütleri, çocukların sıvı durumunun değerlendirilmesine yardımcı olacaktır. Son kılavuzlara göre pediatrik intravenöz sıvı tedavisi olarak yeterli elektrolit bileşimine sahip izotonik solüsyonlar kullanılmalıdır. Çoğu pediatrik hastanın başlangıç yönetiminde kristalloidler kolloidlere tercih edilir, ancak sıvı yönetimi her bir hasta faktörüne göre uyarlanmalı ve perioperatif dönem boyunca sürekli izlenmelidir.

Keywords

Anestezi , Sıvı Tedavisi , İntravenöz İnfüzyonlar , Pediatri , Perioperatif Bakım.

Pediatric Intraoperative Fluid Therapy in Anesthesiology

Abstract

Pediatric anesthesia requires careful consideration of fluid and electrolyte management due to the distinct physiological properties of children. Knowledge of postnatal adaptations is critical in avoiding complications from dehydration or overhydration. Children have a higher percentage of total body water, which makes them more vulnerable to imbalances in fluids. Insensible losses depend on respiratory rates and environmental conditions; otherwise, loss would result in dehydration if not corrected promptly. The neonatal renal physiology affects the filtration of fluids and the management of electrolytes, thus requiring individualized fluid therapy for neonates. Hormonal control, crossed capillary hydrodynamics, metabolic factors, and electrolyte equilibrium complicate pediatric fluid therapy further. Clinical evaluation measures aided by high-tech monitoring and multimodal methods will help assess children’s fluid status. Isotonic solutions with adequate electrolyte composition are to be used as pediatric intravenous fluid therapy according to the recent guidelines. Crystalloids are preferred over colloids in the initial management of most pediatric patients. Recent evidence supports the use of isotonic balanced crystalloids to minimize iatrogenic complications such as hyponatremia and hyperchloremic acidosis, with ongoing monitoring tailored to individual patient needs.

Keywords

Anesthesia , Fluid Therapy , Intravenous Infusions , Pediatrics , Perioperative Care.

Supporting Institution

This study did not receive any institutional or funding support.

References

• 1. Lee H, Kim JT. Pediatric perioperative fluid management. Korean J Anesthesiol. 2023;76(6):519-30. doi:10.4097/kja.23128
• 2. Mathew A, Rai E. Pediatric perioperative fluid management. Saudi J Anaesth. 2021;15(4):435-40. doi:10.4103/sja.sja_140_21
• 3. Iacobelli S, Guignard JP. Maturation of glomerular filtration rate in neonates and infants: an overview. Pediatr Nephrol. 2021;36(6):1439-46. doi:10.1007/s00467-020-04632-1
• 4. Al Awad EH, Yusuf K, Soraisham AS, Obaid H, Sundaram A, Samedi V, et al.. Transient Hyperaldosteronism and Neonatal Hypertension: Case Series and Literature Review. J Clin Neonatol. 2018;7(3):185-9. doi:10.4103/jcn.JCN_57_18
• 5. Rao S, Pena C, Shurmur S, Nugent K. Atrial Natriuretic Peptide: Structure, Function, and Physiological Effects: A Narrative Review. Curr Cardiol Rev. 2021;17(6):e051121191003. doi:10.2174/1573403X17666210202102210
• 6. Weaver LJ, Travers CP, Ambalavanan N, Askenazi D. Neonatal fluid overload-ignorance is no longer bliss. Pediatr Nephrol. 2023;38(1):47-60. doi:10.1007/s00467-022-05514-4
• 7. Bunt JE, Rietveld T, Schierbeek H, Wattimena JL, Zimmermann LJ, van Goudoever JB. Albumin synthesis in preterm infants on the first day of life studied with [1-13C]leucine. Am J Physiol Gastrointest Liver Physiol. 2007;292(4):G1157-61. doi:10.1152/ajpgi.00300.2006
• 8. Stanski NL, Gist KM, Pickett K, Brinton JT, Sadlowski J, Wong HR, et al.. Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation. BMC Nephrol. 2022;23(1):388. doi:10.1186/s12882-022-03009-w
• 9. Semler MW, Self WH, Rice TW. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(20):1951. doi:10.1056/NEJMc1804294
• 10. Arya V, Kavitha M, Mittal K, Gehlawat VK. Plasmalyte versus normal saline as resuscitation fluid in children: A randomized controlled trial. Journal of Pediatric Critical Care. 2021;8(3):134-8. doi:10.4103/jpcc.jpcc_14_21
• 11. Committee on F, Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575-9. doi:10.1542/peds.2010-3851
• 12. Iacobelli S, Guignard JP. Renal aspects of metabolic acid-base disorders in neonates. Pediatr Nephrol. 2020;35(2):221-8. doi:10.1007/s00467-018-4142-9
• 13. Ramanan M, Hammond N, Billot L, Delaney A, Devaux A, Finfer S, et al.. Serum chloride concentration and outcomes in adults receiving intravenous fluid therapy with a balanced crystalloid solution or 0.9% sodium chloride. Intensive Care Med. 2025;51(2):249-58. doi:10.1007/s00134-024-07764-2
• 14. Rasmussen AH, Wehberg S, Fenger-Groen J, Christesen HT. Retrospective evaluation of a national guideline to prevent neonatal hypoglycemia. Pediatr Neonatol. 2017;58(5):398-405. doi:10.1016/j.pedneo.2016.12.002
• 15. Bateman BT, Patorno E, Desai RJ, Seely EW, Mogun H, Maeda A, et al.. Late Pregnancy beta Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia. Pediatrics. 2016;138(3):e20160731. doi:10.1542/peds.2016-0731
• 16. Leelanukrom R, Cunliffe M. Intraoperative fluid and glucose management in children. Paediatr Anaesth. 2000;10(4):353-9. doi:10.1046/j.1460-9592.2000.00536.x
• 17. Becke K, Eich C, Hohne C, Johr M, Machotta A, Schreiber M, et al.. Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA). Paediatr Anaesth. 2018;28(7):588-96. doi:10.1111/pan.13383
• 18. Floh AA, Manlhiot C, Redington AN, McCrindle BW, Clarizia NA, Caldarone CA, et al.. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg. 2015;150(3):498-504 e1. doi:10.1016/j.jtcvs.2015.06.028
• 19. Kostopoulou E, Sinopidis X, Fouzas S, Gkentzi D, Dassios T, Roupakias S, et al.. Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls. Diagnostics (Basel). 2023;13(15):2602. doi:10.3390/diagnostics13152602
• 20. Sumpelmann R, Becke K, Crean P, Johr M, Lonnqvist PA, Strauss JM, et al.. European consensus statement for intraoperative fluid therapy in children. Eur J Anaesthesiol. 2011;28(9):637-9. doi:10.1097/EJA.0b013e3283446bb8
• 21. de Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH, et al.. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes. 2022;23(8):1270-6. doi:10.1111/pedi.13455
• 22. Feld LG, Neuspiel DR, Foster BA, Leu MG, Garber MD, Austin K, et al.. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018;142(6):e20183083. doi:10.1542/peds.2018-3083
• 23. Ayus JC, Achinger SG, Arieff A. Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Renal Physiol. 2008;295(3):F619-24. doi:10.1152/ajprenal.00502.2007
• 24. Oh GJ, Sutherland SM. Perioperative fluid management and postoperative hyponatremia in children. Pediatr Nephrol. 2016;31(1):53-60. doi:10.1007/s00467-015-3081-y
• 25. Hill LL. Body composition, normal electrolyte concentrations, and the maintenance of normal volume, tonicity, and acid-base metabolism. Pediatr Clin North Am. 1990;37(2):241-56. doi:10.1016/s0031-3955(16)36865-1
• 26. Eaddy N, Watene C. Perioperative management of fluids and electrolytes in children. BJA Educ. 2023;23(7):273-8. doi:10.1016/j.bjae.2023.03.006
• 27. Kight BP, Waseem M. Pediatric Fluid Management. StatPearls. StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
• 28. Heal C, Harvey A, Brown S, Rowland AG, Roland D. The association between temperature, heart rate, and respiratory rate in children aged under 16 years attending urgent and emergency care settings. Eur J Emerg Med. 2022;29(6):413-6. doi:10.1097/MEJ.0000000000000951
• 29. De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care. 2018;22(1):43. doi:10.1186/s13054-018-1959-3
• 30. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172-8. doi:10.1378/chest.07-2331
• 31. Cecconi M, Aya HD. Central venous pressure cannot predict fluid-responsiveness. Evid Based Med. 2014;19(2):63. doi:10.1136/eb-2013-101496
• 32. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121(6):2000-8. doi:10.1378/chest.121.6.2000
• 33. Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642-7. doi:10.1097/CCM.0b013e3181a590da
• 34. Costlow L. Maintenance Intravenous Fluids in Children: AAP Provides Recommendations. Am Fam Physician. 2019;100(4):251.
• 35. Holliday MA, Ray PE, Friedman AL. Fluid therapy for children: facts, fashions and questions. Arch Dis Child. 2007;92(6):546-50. doi:10.1136/adc.2006.106377
• 36. Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med. 2014;3(4):95-101. doi:10.5492/wjccm.v3.i4.95
• 37. McNab S, Ware RS, Neville KA, Choong K, Coulthard MG, Duke T, et al.. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014;2014(12):CD009457. doi:10.1002/14651858.CD009457.pub2
• 38. Sarnaik AP, Meert K, Hackbarth R, Fleischmann L. Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy. Crit Care Med. 1991;19(6):758-62. doi:10.1097/00003246-199106000-00005
• 39. Bezinover D, Nahouraii L, Sviatchenko A, Wang M, Kimatian S, Saner FH, et al.. Hyponatremia Is Associated With Increased Mortality in Children on the Waiting List for Liver Transplantation. Transplant Direct. 2020;6(10):e604. doi:10.1097/txd.0000000000001050
• 40. Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012;256(1):18-24. doi:10.1097/SLA.0b013e318256be72
• 41. Lehr AR, Rached-d'Astous S, Barrowman N, Tsampalieros A, Parker M, McIntyre L, et al.. Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis. Pediatr Crit Care Med. 2022;23(3):181-91. doi:10.1097/pcc.0000000000002890
• 42. Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, et al.. ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis. Intensive Care Med. 2022;48(12):1691-708. doi:10.1007/s00134-022-06882-z
• 43. Sumpelmann R, Becke K, Brenner S, Breschan C, Eich C, Hohne C, et al.. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Paediatr Anaesth. 2017;27(1):10-8. doi:10.1111/pan.13007
• 44. Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. JPEN J Parenter Enteral Nutr. 2013;37(5):21-9. doi:10.1177/0148607113496117
• 45. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109-17. doi:10.1093/bja/85.1.109
• 46. Yuki K, Matsunami E, Tazawa K, Wang W, DiNardo JA, Koutsogiannaki S. Pediatric Perioperative Stress Responses and Anesthesia. Transl Perioper Pain Med. 2017;2(1):1-12.
• 47. Lindestam U, Norberg Å, Frykholm P, Rooyackers O, Andersson A, Fläring U. Balanced electrolyte solution with 1% glucose as intraoperative maintenance fluid in infants: a prospective study of glucose, electrolyte, and acid-base homeostasis. Br J Anaesth. 2024;134(5):1432-9. doi:10.1016/j.bja.2024.08.041
• 48. Sumpelmann R, Mader T, Eich C, Witt L, Osthaus WA. A novel isotonic-balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post-authorization safety study (PASS). Paediatr Anaesth. 2010;20(11):977-81. doi:10.1111/j.1460-9592.2010.03428.x
• 49. Datta PK, Pawar DK, Baidya DK, Maitra S, Aravindan A, Srinivas M, et al.. Dextrose-containing intraoperative fluid in neonates: a randomized controlled trial. Paediatr Anaesth. 2016;26(6):599-607. doi:10.1111/pan.12886
• 50. Vetter L, Sümpelmann R, Rudolph D, Röher K, Vetter M, Boethig D, et al.. Short anesthesia without intravenous fluid therapy in children: Results of a prospective non-interventional multicenter observational study. Paediatr Anaesth. 2024;34(5):454-8. doi:10.1111/pan.14847
• 51. Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg. 2010;110(2):375-90. doi:10.1213/ANE.0b013e3181b6b3b5
• 52. Inata Y, Nakagami-Yamaguchi E, Hatachi T, Ito Y, Akamatsu T, Takeuchi M. Reducing Human Album Solution Use in the Pediatric Intensive Care Unit. Pediatr Qual Saf. 2023;8(4):e667. doi:10.1097/pq9.0000000000000667
• 53. Zdolsek M, Hahn RG. Kinetics of 5% and 20% albumin: A controlled crossover trial in volunteers. Acta Anaesthesiol Scand. 2022;66(7):847-58. doi:10.1111/aas.14074
• 54. Weil MH, Henning RJ, Puri VK. Colloid oncotic pressure: clinical significance. Crit Care Med. 1979;7(3):113-6. doi:10.1097/00003246-197903000-00006
• 55. Zou Y, Ma K, Xiong J-B, Xi C-H, Deng X-J. Comparison of the effects of albumin and crystalloid on mortality among patients with septic shock: systematic review with meta-analysis and trial sequential analysis. Sao Paulo Med J. 2018;136(05):421-32. doi:10.1590/1516-3180.2017.0285281017
• 56. Patel A, Laffan MA, Waheed U, Brett SJ. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ. 2014;349(22):g4561. doi:10.1136/bmj.g4561.
• 57. Piazza O, Scarpati G, Tufano R. Update on transfusion solutions during surgery: review of hydroxyethyl starches 130/0.4. Int J Gen Med. 2010;3:287-95. doi:10.2147/IJGM.S3495
• 58. Thy M, Montmayeur J, Julien-Marsollier F, Michelet D, Brasher C, Dahmani S, et al.. Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery: A systematic review and meta-analysis. Eur J Anaesthesiol. 2018;35(7):484-95. doi:10.1097/EJA.0000000000000780
• 59. Base E, Standl T, Mahl C, Jungheinrich C. Comparison of 6% HES 130/0.4 in a balanced electrolyte solution versus 6% HES 130/0.4 in saline solution in cardiac surgery. Crit Care. 2006;10(1):176. doi:10.1186/cc4523
• 60. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al.. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901-11. doi:10.1056/NEJMoa1209759
• 61. Hartog CS, Reuter D, Loesche W, Hofmann M, Reinhart K. Influence of hydroxyethyl starch (HES) 130/0.4 on hemostasis as measured by viscoelastic device analysis: a systematic review. Intensive Care Med. 2011;37:1725-37. doi:10.1007/s00134-011-2385-z
• 62. Navickis RJ, Haynes GR, Wilkes MM. Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass: a meta-analysis of randomized trials. J Thorac Cardiovasc Surg. 2012;144(1):223-30. doi:10.1016/j.jtcvs.2012.04.009
• 63. Van Der Linden P, James M, Mythen M, Weiskopf RB. Safety of modern starches used during surgery. Anesth Analg. 2013;116(1):35-48. doi:10.1213/ANE.0b013e31827175da
• 64. Haas T, Preinreich A, Oswald E, Pajk W, Berger J, Kuehbacher G, et al.. Effects of albumin 5% and artificial colloids on clot formation in small infants. Anaesthesia. 2007;62(10):1000-7. doi:10.1111/j.1365-2044.2007.05186.x
• 65. Saudan S. Is the use of colloids for fluid replacement harmless in children? Curr Opin Anaesthesiol. 2010;23(3):363-7. doi:10.1097/ACO.0b013e328339384e
• 66. Thomas-Rueddel DO, Vlasakov V, Reinhart K, Jaeschke R, Rueddel H, Hutagalung R, et al.. Safety of gelatin for volume resuscitation--a systematic review and meta-analysis. Intensive Care Med. 2012;38(7):1134-42. doi:10.1007/s00134-012-2560-x
• 67. Mitra S, Khandelwal P. Are All Colloids Same? How to Select the Right Colloid? Indian Journal of Anaesth. 2009;53:592-607.
• 68. Shiratori T, Sato A, Fukuzawa M, Kondo NI, Tanno S. Severe Dextran-Induced Anaphylactic Shock during Induction of Hypertension-Hypervolemia-Hemodilution Therapy following Subarachnoid Hemorrhage. Case Rep Crit Care. 2015;2015:967560. doi:10.1155/2015/967560
• 69. Akech S, Ledermann H, Maitland K. Choice of fluids for resuscitation in children with severe infection and shock: systematic review. BMJ. 2010;341:c4416. doi:10.1136/bmj.c4416