Omoifo Casmir Edobor, Edomwonyi Nosa Philomena, Idogun Sylvester Eshiotseme
Departments of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Departments of Chemical Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Afr J Paediatr Surg. 2018 Apr-Jun;15(2):69-72. doi: 10.4103/ajps.AJPS_40_16.
It is a common practice to administer 4.3% dextrose in 0.18% saline peri-operatively and for routine fluid maintenance in the paediatric age group. Concerns have been expressed about the risk of hyponatraemia associated with the administration of hypotonic intravenous fluids, hence the need to re-evaluate our practice. This study aims to evaluate the relative incidence of intra-operative hyponatraemia following the use of isotonic and hyopotonic intravenous fluids.
This randomised double-blind clinical trial recruited consecutive American Society of Anaesthesiologists physical status Class I and II children aged between 6 months and 17 years scheduled for various minor elective surgical procedures. The patients received one of 3 intravenous infusions for intra-operative fluid management. Group I received 4.3% dextrose in 0.18 saline (n = 25), Group II received normal saline (n = 20) and Group III received Ringer's lactate (n = 20). Blood samples were collected before the surgery and at the end of surgery for serum electrolytes.
One patient in each group developed moderate hyponatraemia intraoperatively. This constituted a 4% (1/25) incidence of intra-operative hyponatraemia among patients who had hypotonic maintenance fluid and a 5% (2/40) incidence in the isotonic maintenance groups. The incidence of hyponatraemia was therefore comparable between patients who had hypotonic and isotonic intra-operative maintenance fluids (P = 1.000).
We conclude that healthy children who have intraoperative hypotonic maintenance fluids during minor elective surgeries are not exposed to the additional risk of hyponatraemia compared to those who have isotonic fluids. The study of a larger sample size is recommended to further validate our findings.
在围手术期以及小儿年龄组的常规液体维持治疗中，给予0.18% 生理盐水加4.3% 葡萄糖是一种常见做法。人们对给予低渗静脉输液相关的低钠血症风险表示担忧，因此有必要重新评估我们的做法。本研究旨在评估使用等渗和低渗静脉输液后术中低钠血症的相对发生率。
这项随机双盲临床试验招募了连续的美国麻醉医师协会身体状况分级为I级和II级、年龄在6个月至17岁之间、计划进行各种小型择期外科手术的儿童。患者接受3种静脉输液之一用于术中液体管理。第一组接受0.18% 生理盐水加4.3% 葡萄糖（n = 25），第二组接受生理盐水（n = 20），第三组接受乳酸林格氏液（n = 20）。在手术前和手术结束时采集血样检测血清电解质。
每组各有1例患者术中发生中度低钠血症。在接受低渗维持液的患者中，术中低钠血症的发生率为4%（1/25），在等渗维持液组中为5%（2/40）。因此，术中接受低渗和等渗维持液的患者低钠血症发生率相当（P = 1.000）。
我们得出结论，与接受等渗液的健康儿童相比，在小型择期手术中接受术中低渗维持液的健康儿童不会面临额外的低钠血症风险。建议进行更大样本量的研究以进一步验证我们的发现。
