Hastings Laura A, Wood John C, Harris Bryan, Von Busse Sabine, Drachenberg Ana, Dorey Frederick, Bushman Gerald A
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA.
Anesth Analg. 2008 Dec;107(6):1840-7. doi: 10.1213/ane.0b013e318189adcf.
Preoperative laboratory examination of patients undergoing elective surgical procedures has been routinely performed for decades. Although there is a large body of literature concerning the appropriate preoperative assessment of adult patients, corresponding literature for the pediatric population is not as well defined. Children and young adults with cardiac disease are a particularly vulnerable subset of patients who often undergo an extensive battery of preoperative laboratory testing. We examined the serum chemistry profiles for children with cardiac disease presenting for outpatient surgery. The investigation aims to define the effectiveness of preoperative electrolyte determination in this population of children and young adults.
A retrospective chart review of all children presenting as outpatients to a tertiary care, freestanding children's hospital for elective cardiac surgery between January 1, 2000 and January 31, 2003 was performed. All patient charts in which the admission date matched the cardiac surgical date were examined. Patients were excluded if the preoperative laboratory evaluation was performed outside of our facility, preoperative laboratory investigation was not performed, or the patient was transported by medical transport to our hospital. Patients were grouped according to three methods: the number of cardiac medications (none to four), and cardiac medications, noncardiac medications, and no medications. The presence of electrolyte abnormalities was also examined in the context of cardiac medications with various pharmacologic effects. The primary outcome measure was the incidence of abnormal laboratory values for children taking various cardiac medications.
Of the 933 initial entries found, 774 met the investigational criteria and were included in the analysis. Although statistically significant differences in preoperative electrolytes were associated with the use of cardiac and noncardiac medication, there was no clinical value to this correlation. The data demonstrate a very low incidence of hypokalemia and hypomagnesemia in the entire study population.
Preoperative electrolyte disturbances in children and young adults presenting for cardiac surgery are uncommon. The concern of hypokalemia or hypomagnesemia important in the adult population taking cardiac medications was not identified in the pediatric population. These data do not support the need for routine preoperative electrolyte evaluation in children taking cardiac medications.
几十年来，接受择期外科手术患者的术前实验室检查一直是常规操作。尽管有大量关于成年患者术前适当评估的文献，但针对儿科人群的相应文献定义并不明确。患有心脏病的儿童和青少年是特别脆弱的患者群体，他们通常要接受一系列广泛的术前实验室检查。我们研究了前来接受门诊手术的心脏病患儿的血清化学指标。本研究旨在确定术前电解质测定在这群儿童和青少年中的有效性。
对2000年1月1日至2003年1月31日期间在一家三级护理独立儿童医院接受择期心脏手术的所有门诊患儿进行回顾性病历审查。检查所有入院日期与心脏手术日期匹配的患者病历。如果术前实验室评估在我们机构之外进行、未进行术前实验室检查或患者由医疗转运至我院，则将患者排除。患者按三种方法分组：心脏药物数量（无至四种），以及心脏药物、非心脏药物和无药物。还在具有各种药理作用的心脏药物背景下检查电解质异常的存在情况。主要观察指标是服用各种心脏药物的儿童实验室值异常的发生率。
在最初找到的933份记录中，774份符合研究标准并纳入分析。尽管术前电解质的统计学显著差异与心脏药物和非心脏药物的使用有关，但这种相关性无临床意义。数据显示整个研究人群中低钾血症和低镁血症的发生率非常低。
接受心脏手术的儿童和青少年术前电解质紊乱并不常见。在儿科人群中未发现成年心脏药物使用者中重要的低钾血症或低镁血症问题。这些数据不支持对服用心脏药物的儿童进行常规术前电解质评估。
