J Clin Monit Comput - The use of a noninvasive hemoglobin monitor for determining fluid distribution and elimination in pediatric patients undergoing minor surgery.


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In pediatric fluid therapy it would be preferable to describe distribution and elimination a fluid bolus based on repetitive hemoglobin (Hb) according to kinetic principles. Pulse CO-Oximetry is a recent advancement in patient monitoring that allows for the continuous noninvasive measurement of Hb (SpHb). The aim of this study was to describe the distribution and elimination of hydroxyethylstarch (HES) 130/0.4 in combination with crystalloids using a noninvasive Hb monitor in two cohorts of young children undergoing minor surgeries under general anesthesia. Two cohorts, 16 children aged 1-3?years and 12 aged 4-6?years, were investigated during anesthesia and minor surgical procedures. They were given a maintenance solution of lactated Ringer's and a fluid bolus of HES 130/0.4, 6?mL/kg over a period of 20?min. The whole procedure lasted 120?min, and SpHb values were measured every 10?min. The SpHb values were used to calculate plasma dilution, net volume, and mean residence time (MRT) of the infused fluid. A total of 377 measured SpHbs generated individual dilution plots that showed variability, particularly for the older cohort. Distribution and elimination rates of the infused fluid were calculated. Mean dilution plots were generated. There were no significant differences in dilution, net volume or MRT between groups. A non invasive Hb analyzer could be used to calculate fluid distribution. The variability in the data can probably be explained by reactions to anesthetic drugs, variability in measurement technique, variability in generating the complex capillary signals, and individual variability in baseline fluid status. The latter finding is important because this is a prerequisite for perioperative fluid planning for each individual.

Resumo Limpo

pediatr fluid therapi prefer describ distribut elimin fluid bolus base repetit hemoglobin hb accord kinet principl puls cooximetri recent advanc patient monitor allow continu noninvas measur hb sphb aim studi describ distribut elimin hydroxyethylstarch hes combin crystalloid use noninvas hb monitor two cohort young children undergo minor surgeri general anesthesia two cohort children age year age year investig anesthesia minor surgic procedur given mainten solut lactat ringer fluid bolus hes mlkg period min whole procedur last min sphb valu measur everi min sphb valu use calcul plasma dilut net volum mean resid time mrt infus fluid total measur sphbs generat individu dilut plot show variabl particular older cohort distribut elimin rate infus fluid calcul mean dilut plot generat signific differ dilut net volum mrt group non invas hb analyz use calcul fluid distribut variabl data can probabl explain reaction anesthet drug variabl measur techniqu variabl generat complex capillari signal individu variabl baselin fluid status latter find import prerequisit periop fluid plan individu

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