Perfusion intraveineuse périanesthésique chez le nourrisson et l'enfant : Que faire sans le B66 ?

Intraoperative infusion is intended to supplement the fluid and electrolyte needs. The essential purpose of this support is to maintain a balance between losses and inflows of water, electrolytes and glucose. The specific functional and structural development of the child results in a higher metabolism than adults, consuming more oxygen and calories. In addition, the body fluid compartment is even more important that the child is younger. Specific rules of fluid management have been established taking into account the surgical and preoperative fasting context in children. The choice of perioperative fluid therapy is essential, and can lead to dramatic complications in case of unsuitable choice to the clinical situation (severe hyponatremia, hypo- or hyperglycemia). In France, a widely used polyionic i.v. solution, containing 0.9 % dextrose and called “B66” has known an interruption of marketing in 2015. Some European countries have marketed balanced isotonic fluids with electrolytes and a low concentration of glucose but these products are not available for French anesthetist. Consistent with the practice performed in many French pediatric centers, the Association of French-speaking anesthetists (Adarpef) proposed an alternative to the “B66 solution” including Ringer Lactate and 30 % glucose, pending commercialization of tailored solutions. As a reminder, a consensus of European pediatric anesthesiologists has determined that an appropriate solution for intraoperative fluid therapy in children must have an osmolarity and sodium content close to physiological plasma, added to 1 to 2.5 % glucose, and including anions metabolic as precursors of bicarbonates to avoid significant disruption of the acid-base balance. Careful intraoperative monitoring and adjustment of the i.v. infusion rate as needed are crucial steps in the good management of children.