RESUMO
The European recommendations on perioperative maintenance fluids in children have recently been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations. In Belgium, however, the commercially approved solutions do not match with these recommendations and there is neither consensus nor mandate about the composition and volume of perioperative maintenance fluids in children undergoing surgery despite the continuing controversy in literature. This paper highlights the significant challenges and shortcomings while prescribing fluid therapy for pediatric surgical patients in Belgium. It is sensible to the authors to address these issues with national guidance through an organization such as The Belgian Association for Paediatric Anaesthesiology, and to propose Belgian recommendations on perioperative fluid management in surgical children, with the intention of improving the quality of care in this population.
Assuntos
Hidratação/normas , Assistência Perioperatória/normas , Bélgica , Criança , Humanos , Hiperglicemia/prevenção & controle , Hiponatremia/prevenção & controle , Procedimentos Cirúrgicos OperatóriosAssuntos
Coloides/uso terapêutico , Assistência Perioperatória/métodos , Substitutos do Plasma/uso terapêutico , Coloides/economia , Soluções Cristaloides , Humanos , Soluções Isotônicas , Metanálise como Assunto , Assistência Perioperatória/economia , Substitutos do Plasma/economia , Soluções para Reidratação/economia , Soluções para Reidratação/uso terapêuticoRESUMO
The use of high epidural anesthesia for cesarean section has generally been accepted as a safe and comfortable means of intra- and post-operative pain relief in recent years. However, the accompanying vasomotor blockade of the lower body and the sometimes impaired cardiac reflex activity restrict the use of concomitant--even local--medication. Described are the deleterious side effects on hemodynamic stability and patient comfort of an intramyometrically administered synthetic prostaglandin E (PGE2)-compound (dinoprostone) given to three female patients under high epidural anesthesia during cesarean section. Differentiation of the various symptoms is made in relation to their epidural or PGE origin or to a combination of the two. A striking therapeutic resistance of the hypotension of a sufficiently volume-expanded patient to even large doses of ephedrine is discussed as representing possible PGE-mediated suppression of peripheral norepinephrine release.