A novel isotonic-balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post-authorization safety study (PASS).
BACKGROUND
The recommendations for intraoperative fluid therapy in children have been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations (1-2.5% instead of 5%) to avoid hyponatremia and hyperglycemia.


OBJECTIVE
The objective of this prospective multicentre observational post-authorization safety study was to evaluate the intraoperative use of a novel isotonic-balanced electrolyte solution with 1% glucose (BS-G1) with a particular focus on changes in acid-base status, electrolyte and glucose concentrations.


METHODS
Following local ethics committee approval, pediatric patients aged up to 4 years with an ASA risk score of I-III undergoing intraoperative administration of BS-G1 were enrolled. Patient demographics, the performed procedure, adverse drug reactions, hemodynamic data, and the results of blood gas analysis before and after infusion were documented with a focus on changes in acid-base status, electrolyte and glucose concentrations.


RESULTS
In 107 patients (ASA I-III; age 16.2 ± 15.4, range day of birth to 47.7 months; body weight 8.8 ± 4.8, range 1.6-18.8 kg), the mean volume infused was 20 ± 12.6 (range 3.6-83.3) ml·kg(-1) BS-G1. During the infusion, hemoglobin, hematocrit, anion gap, strong ion difference, and calcium decreased and chloride and glucose increased significantly within the physiologic range. All other measured parameters including sodium, bicarbonate, base excess, and lactate remained stable. Neither hypoglycemia (glucose <2.5 mmol·l(-1) ) nor hyperglycemia (glucose >10 mmol·l(-1) ) was documented after BS-G1 infusion. No adverse drug reactions were reported.


CONCLUSIONS
The studied isotonic-balanced electrolyte solution with 1% glucose helps to avoid perioperative acid-base imbalance, hyponatremia, hyperglycemia, and ketoacidosis in infants and toddlers and may therefore enhance patient safety.
Sümpelmann
Robert
R
Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin-OE 8050, Hannover, Germany. suempelmann.robert@mh-hannover.de
Mader
Thomas
T
Eich
Christoph
C
Witt
Lars
L
Osthaus
Wilhelm A
WA
D000136:Acid-Base Equilibrium / Q000187:drug effects; D001786:Blood Glucose / Q000378:metabolism; D002675:Child, Preschool; D004573:Electrolytes / Q000008:administration & dosage / Q000097:blood / Q000737:chemistry; D005260:Female; D005440:Fluid Therapy; D005947:Glucose / Q000008:administration & dosage / Q000737:chemistry; D006801:Humans; D007038:Hypotonic Solutions / Q000009:adverse effects* / Q000737:chemistry / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D008297:Male; D011446:Prospective Studies; D012449:Safety
D001786:Blood Glucose; D004573:Electrolytes; D007038:Hypotonic Solutions; D005947:Glucose