Advertisement

Specific Aspects of Positioning, Fluids, Glucose Control, and Temperature Management

  • Gerhard K. Wolf
  • Sulpicio G. Soriano
  • John H. Arnold
Chapter

Abstract

In pediatrics, patient positioning for surgery requires careful preoperative planning to allow adequate access to the patient for both the neurosurgeon and the anesthesiologist.

Infants and small children are especially susceptible to hypothermia. Active warming devices, humidification/warming of inspired gas, and increasing the ambient temperature are important strategies to maintain normothermia while carefully monitoring the patient’s body temperature. Both hypothermia and fever may produce a worse outcome.

Neurosurgical patients are at particular risk for electrolyte derangements through iatrogenic factors (infusion of hypotonic fluids, large fluid shifts) and changes induced by cerebral salt wasting (CSW), diabetes insipidus (DI), and syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is characterized by free water retention; ADH levels are inappropriately elevated. DI is characterized by lack of ADH, polyuria, and hypernatremia. Cerebral salt wasting is probably a less common cause of hyponatremia, while the underlying mechanism of sodium loss is poorly understood.

Urine output and serum electrolytes are all influenced by SIADH, DI, and CSW. However, assessment of urine output and serum electrolytes can lead to conflicting interpretation of the patient’s underlying physiologic status: urine output is high in both DI (inability to concentrate urine) and CSW (osmotic diuresis with sodium loss); serum sodium can be low in SIADH (excess of free water) and CSW (loss of sodium).

Keywords

Diabetes insipidus Cerebral salt wasting Thermal homeostasis Positioning Glucose control 

Suggested Reading

  1. Cochran A, Scaife ER, Hansen KW, Downey EC. Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma. 2003;55(6):1035–8.CrossRefGoogle Scholar
  2. Grady MS, Bedford RF, Park TS. Changes in superior sagittal sinus pressure in children with head elevation, jugular venous compression, and PEEP. J Neurosurg. 1986;65(2):199–202.CrossRefGoogle Scholar
  3. Halberthal M, Halperin ML, Bohn D. Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ. 2001;322(7289):780–2.CrossRefGoogle Scholar
  4. Singh S, Bohn D, Carlotti AP, Cusimano M, Rutka JT, Halperin ML. Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit Care Med. 2002;30(11):2575–9.CrossRefGoogle Scholar
  5. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449–61.CrossRefGoogle Scholar
  6. Wise-Faberowski L, Soriano SG, Ferrari L, McManus ML, Wolfsdorf JI, Majzoub J, Scott RM, Truog R, Rockoff MA. Perioperative management of diabetes insipidus in children [corrected]. J Neurosurg Anesthesiol. 2004;16(1):14–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Gerhard K. Wolf
    • 1
  • Sulpicio G. Soriano
    • 2
  • John H. Arnold
    • 3
  1. 1.Children’s Hospital TraunsteinTeaching Hospital of Ludwig Maximilians University MunichTraunsteinGermany
  2. 2.Department of Anesthesiology, Perioperative and Pain MedicineBoston Children’s HospitalBostonUSA
  3. 3.Division of Critical Care MedicineChildren’s Hospital Boston, Harvard Medical SchoolBostonUSA

Personalised recommendations