[An audit of perioperative fluid management and electrolyte monitoring in children undergoing surgery for scoliosis].
OBJECTIVE
To audite and compare the perioperative practices of intravenous fluids and electrolyte & glucose monitoring in children undergoing operations for scoliosis in 2008, 2010, prior to and after the publication of guideline in 2009.


METHODS
Retrospective audit was conducted at Peking Union Medical College Hospital, a tertiary referral teaching hospital in Beijing, China. Children under 14 years old with scoliosis treated surgically in 2008 and 2010 were recruited. The following data were collected from medical files: age, gender, weight, duration of hospitalization, concurrent illness, operation, anesthesia, fluid prescribed during perioperative fasting period, electrolyte monitoring and postoperative pain control, etc.


RESULTS
Among 235 American Society of Anesthesiologists (ASA) I-II cases, 75 children received dextrose 5% or saline 0.9% during the preoperative fasting period. Intraoperatively, the anesthesiologists preferred dextrose 5% or saline 0.9% in children under 6 years old (n = 15, 2008; n = 15, 2010) and Ringer's solution in those aged 6 - 14 years (n = 84, 2008; n = 94, 2010) and hypotonic fluid was not used. And 82.3% and 94.3% of them received electrolyte examinations preoperatively. The electrolyte results were unavailable postoperatively in 27/122 (in 2008) and 13/113 (in 2010) and serum electrolytes were not assessed before fluid treatment postoperatively. Electrolytes were monitored only once in 82.3% (in 2008) and 70.5% (in 2010) patients. Compared with the preoperative concentration of sodium ion, the mean decrease was approximately 2.0 mmol/L at Day 1 postoperation. Hyponatremia at Day 1 postoperation in 2010 was more common than that in 2008 (26.2% vs 23.6%; P = 0.044). But no significant difference existed between the incidence of hyperglycemia of the same day in 2008 and that in 2010 (P = 0.306).


CONCLUSIONS
Compared with that in 2008, our recent practice of intravenous fluid prescription and electrolyte monitoring is ill-consistent with the recommendations in 2009. Implementation of optimal perioperative fluid management is warranted.
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China.
Huan-rong
HR
Qiu
Shou-yuan
SY
Tian
Tie-hu
TH
Ye
Bo
B
Zhu
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D019983:Guideline Adherence; D006801:Humans; D007010:Hyponatremia / Q000517:prevention & control; D008297:Male; D008485:Medical Audit; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*