Pediatric Intraoperative Fluid Therapy in Anesthesiology

Pediatric anesthesia requires careful consideration of fluid and electrolyte management due to the distinct physiological properties of children. Knowledge of postnatal adaptations is critical in avoiding complications from dehydration or overhydration. Children have a higher percentage of total body water, which makes them more vulnerable to imbalances in fluids. Insensible losses depend on respiratory rates and environmental conditions; otherwise, loss would result in dehydration if not corrected promptly. The neonatal renal physiology affects the filtration of fluids and the management of electrolytes, thus requiring individualized fluid therapy for neonates. Hormonal control, crossed capillary hydrodynamics, metabolic factors, and electrolyte equilibrium complicate pediatric fluid therapy further. Clinical evaluation measures aided by high-tech monitoring and multimodal methods will help assess children’s fluid status. Isotonic solutions with adequate electrolyte composition are to be used as pediatric intravenous fluid therapy according to the recent guidelines. Crystalloids are preferred over colloids in the initial management of most pediatric patients. Recent evidence supports the use of isotonic balanced crystalloids to minimize iatrogenic complications such as hyponatremia and hyperchloremic acidosis, with ongoing monitoring tailored to individual patient needs.