[Perioperative Infusion Therapy in Children].

The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative infusion therapy in children may lead to serious complications and a negative outcome. Therefore, in this review historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy. Recent studies showed that optimized preoperative fasting times and liberal clear fluid intake until 1 h improve patient comfort and metabolic and haemodynamic condition after induction of anaesthesia. Physiologically composed balanced isotonic electrolyte solutions are safer than hypotonic electrolyte solutions or saline 0.9% to protect young children against the risks of hyponatraemia and hyperchloremic acidosis. For intraoperative maintenance infusion, addition of 1 - 2% glucose is sufficient to avoid hypoglycaemia, lipolysis or hyperglycaemia. Modified fluid gelatine or hydroxyethyl starch in balanced electrolyte solution can safely be used to quickly normalize blood volume in case of perioperative circulatory instability and blood loss. In conclusion, physiologically composed infusion solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in children with pre-existing imbalances and have a wide safety margin in case of accidental hyperinfusion. Georg Thieme Verlag KG Stuttgart · New York.