Way C, Dhamrait R, Wade A, Walker I
Department of Anaesthesia, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
Br J Anaesth. 2006 Sep;97(3):371-9. doi: 10.1093/bja/ael185. Epub 2006 Jul 27.
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.
Questionnaire survey of 477 consultant anaesthetists in two training areas in the UK.
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).
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.
儿童液体疗法可能与医源性低钠血症相关。我们调查了麻醉医生在围手术期当前的液体处方实践、科室液体方案以及对皇家儿科学会和儿童健康学会（RCPCH）关于儿童使用4%葡萄糖/0.18%盐水的担忧的认知情况。
对英国两个培训地区的477名麻醉科顾问医生进行问卷调查。
收到了289名麻醉医生的回复（60.6%）——对203名麻醉儿童的顾问医生的回复进行了分析。共有67.7%的人没有当地科室的液体处方政策，58.1%的人不知道RCPCH的担忧。共有60.1%的麻醉医生表示他们在术中开具低渗葡萄糖盐溶液，75.2%的人在术后开具。在专科儿童医院工作的麻醉医生术中开具等渗液体的可能性是在地区医院工作的麻醉医生的5.1倍（95%可信区间1.48 - 17.65，P = 0.01），但他们在术后都开具低渗葡萄糖盐溶液。81.8%的麻醉医生引用了霍利迪和西加尔维持液公式；只有5.9%的麻醉医生会在术后立即限制液体摄入。在专科儿童医院工作的麻醉医生术后限制液体摄入的可能性是在地区医院工作的麻醉医生的13.2倍（95%可信区间2.8 - 61.8，P = 0.001）。
麻醉医生开具低渗葡萄糖盐溶液可能使儿童面临医源性低钠血症的风险。儿童围手术期液体处方的科室方案并不常见。我们建议需要国家指导。
