Perioperative Crystalloid and Colloid Fluid Management in Children: Where Are We and How Did We Get Here?

It has been more than 50 yr since the landmark article in which Holliday and Segar (Pediatrics 1957;19:823–32) proposed the rate and composition of parenteral maintenance fluids for hospitalized children. Much of our practice of fluid administration in the perioperative period is based on this article. The glucose, electrolyte, and intravascular volume requirements of the pediatric surgical patient may be quite different than the original population described, and consequently, use of traditional hypotonic fluids proposed by Holliday and Segar may cause complications, such as hyperglycemia and hyponatremia, in the postoperative surgical patient. There is significant controversy regarding the choice of isotonic versus hypotonic fluids in the postoperative period. We discuss the origins of perioperative fluid management in children, review the current options for crystalloid fluid management, and present information on colloid use in pediatric patients. 

Fluid management of the pediatric surgical patient presents challenges to both the anesthesia and surgical teams. Typically, the intraoperative management is the responsibility of the anesthesiologist, whereas postoperative orders are written by the surgeons. Both groups rely on formulas and concepts once thought to be certain, but these are presently being examined and challenged, especially in the pediatric literature. The purpose of this review is to outline the history supporting current fluid management strategies and to discuss the effect of recent controversies on future practice decisions. 

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