Betti Céline, Busi Ilaria, Cortesi Cinzia, Anselmi Luciano, Mendoza-Sagaon Mario, Simonetti Giacomo D
Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Eur J Pediatr. 2024 May;183(5):2251-2256. doi: 10.1007/s00431-024-05490-x. Epub 2024 Feb 26.
The purpose of this study is to evaluate the intracellular and extracellular volume before and after anesthesia in order to ascertain their variations and determine the potential utility of this information in optimizing intraoperative fluid administration practices. A bioimpedance spectroscopy device (body composition monitor, BCM) was used to measure total body fluid volume, extracellular volume, and intracellular volume. BCM measurements were performed before and after general anesthesia in unselected healthy children and adolescents visiting the Pediatric Institute of Southern Switzerland for low-risk surgical procedures hydrated with an isotonic solution. In 100 children and adolescents aged 7.0 (4.8-11) years (median and interquartile range), the average total body water increased perioperatively with a delta value of 182 (0-383) mL/m from pre- to postoperatively, as well as the extracellular water content, which had a similar increase with a delta value of 169 (19-307) mL/m. The changes in total body water and extracellular water content significantly correlated with the amount of fluids administered. The intracellular water content did not significantly change. Conclusion: Intraoperative administration of isotonic solutions results in a significant fluid accumulation in low-risk schoolchildren during general anesthesia. The results suggest that children without major health problems undergoing short procedures do not need any perioperative intravenous fluid therapy, because they are allowed to take clear fluids up to 1 h prior anesthesia. In future studies, the use of BCM measurements has the potential to be valuable in guiding intraoperative fluid therapy. What is Known: • Most children who undergo common surgical interventions or investigations requiring anesthesia are nowadays hydrated at a rate of 1700 mL/m/day with an isotonic solution. • The use bioimpedance spectroscopy for the assessment of fluid status in healthy children has already been successfully validated. • The bioimpedance spectroscopy is already currently widely used in various nephrological settings to calculate fluid overload and determine patient's optimal fluid status. What is New: • Routine intraoperative fluid administration results in a significant fluid accumulation during general anesthesia in low-risk surgical procedures. • This observation might be relevant for children and adolescents with conditions predisposing to fluid retention. • In future studies, the use of BCM measurements has the potential to be valuable in guiding intraoperative fluid therapy.
本研究的目的是评估麻醉前后的细胞内和细胞外容量，以确定其变化情况，并确定这些信息在优化术中液体管理实践中的潜在用途。使用生物电阻抗光谱设备（人体成分监测仪，BCM）测量总体液量、细胞外液量和细胞内液量。对瑞士南部儿科研究所就诊的未选择的健康儿童和青少年进行低风险手术，在全身麻醉前后使用等渗溶液进行水化处理后，用BCM进行测量。在100名年龄为7.0（4.8 - 11）岁（中位数和四分位间距）的儿童和青少年中，围手术期总体水平均增加，术前至术后的差值为182（0 - 383）mL/m，细胞外水含量也有类似增加，差值为169（19 - 307）mL/m。总体水和细胞外水含量的变化与所输注的液体量显著相关。细胞内水含量没有显著变化。结论：在全身麻醉期间，术中给予等渗溶液会导致低风险学龄儿童出现显著的液体蓄积。结果表明，没有重大健康问题且接受短时间手术的儿童不需要任何围手术期静脉输液治疗，因为他们在麻醉前1小时可以饮用清液。在未来的研究中，使用BCM测量在指导术中液体治疗方面可能具有重要价值。已知信息：• 如今，大多数接受需要麻醉的常见手术干预或检查的儿童以每天1700 mL/m的速率用等渗溶液进行水化处理。• 生物电阻抗光谱法用于评估健康儿童的液体状态已得到成功验证。• 生物电阻抗光谱法目前已广泛应用于各种肾脏疾病情况，以计算液体超负荷并确定患者的最佳液体状态。新发现：• 在低风险手术过程中，常规术中液体输注会导致全身麻醉期间出现显著的液体蓄积。• 这一观察结果可能与易发生液体潴留的儿童和青少年有关。• 在未来的研究中，使用BCM测量在指导术中液体治疗方面可能具有重要价值。
