Hypotonic fluids in neonates
In March 2014, BJA published a study on sodium levels in neonates after different types of maintenance IV fluids during abdominal or thoracic surgery. Spoiler alert: Hypotonic fluids resulted in lower postoperative sodium levels. Duh. If you didn’t know this by now, you haven’t been reading the pediatric anesthesia literature over the past decade or two. The authors seems to know this as they point out several times in the article that their study is unique because it included neonates for the first time, and they cite surveys from Great Britain that demonstrate that hypotonic fluids are still used in some centers. I hope this really isn’t true. I’ve been using isotonic fluids in the perioperative period in all aged children since the 1980s, and even surgeons and pediatricians have reverted to use of isotonic fluids in the postoperative period for at least ten years. My friend P.A. Lonnqvist (we enjoyed a beer together in an Indian restaurant in San Francisco at the ASA) wrote an accompanying editorial, which pretty much says the same thing, only with greater tact.