c) Preoperative fluid deficits develop during the period of time in which the child has not received oral or IV maintenance fluids.
d) The preoperative fluid deficit is calculated by determining the hourly maintenance fluid rate and multiplying this rate by the number of hours the child has been without IV or oral intake.
e) The calculated fluid deficit is replaced following the guidelines wherein half of the fluid deficit is replaced during the first hour with the remainder divided in half and replaced over the course of the subsequent 2 hours.
f) In addition to the calculated maintenance and deficit fluids necessary to replace insensible fluid losses, additional IV fluid is required to replace third-space fluid losses that occur with surgical trauma. Lactated Ringer’s solution, 0.9% normal saline, and Plasmalyte are acceptable for the replacement of insensible and third-space fluid losses at the rate of 1 to 2 mL/kg/hr.
g) Expected third-space fluid losses can be categorized as minimal surgical trauma (an additional 3-4 mL/kg/hr), moderate surgical trauma (5-6 mL/kg/hr), and major surgical trauma (7-10 mL/kg/hr).
4. Glucose-containing solutions
a) Most anesthesia providers administer a glucose-free IV solution (lactated Ringer’s solution) for maintenance fluid administration in the replacement of third-space and intraoperative blood loss.
b) If the child has had an extended NPO period, a plasma glucose level may be determined at the time of IV catheter insertion after inhalation induction.
c) Hypoglycemia is likely to develop in a variety of clinical circumstances. Examples include infants who are premature, infants of mothers with diabetes, children with diabetes who have received a portion of daily insulin preoperatively, and children who receive glucose-based parenteral nutrition.
d) A glucose-containing IV solution is administered to these patients as a controlled piggyback infusion with frequent plasma glucose determinations performed to avoid hyperglycemia.
e) Infants born of mothers with diabetes and infants of mothers who receive glucose-containing solutions during labor may require a continuation of these solutions for the prevention of rebound hypoglycemia.
5. Crystalloid intravenous fluids
a) Crystalloid IV solutions are advantageous for perioperative administration because they are the least expensive of the available IV solutions and are acceptable for the replacement of preoperative, intraoperative, and postoperative isotonic fluid deficits. Unlike colloid solutions, crystalloid solutions do not produce allergic reactions.
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