Fluid Therapy for Pediatric Appendicitis

Since children managed for acute abdominal pain due to appendicitis usually have fever, nausea and/or vomiting, and poor fluid intake, we assumed that this group of patients are mildly dehydrated, i.e., <5% loss of body weight upon presentation at our Department of Pediatric Emergency Medicine.^{8 (link)} Therefore, and following our local recommendations for intravenous fluid therapy, all patients were prescribed a balanced crystalloid intravenous infusion at a dose of 50 mL/kg of Ringer’s acetate solution (131 mmol/L sodium, 4 mmol/L potassium, 2 mmol/L magnesium, 110 mmol/L chloride, 30 mmol/L acetate; Fresenius Kabi®) over 4 h. The infusion of this near-isotonic solution was followed by a maintenance fluid and electrolyte therapy phase consisting of a hypotonic 0.46% normal sodium chloride (80 mmol/L sodium, 20 mmol/L potassium, 100 mmol/L chloride in 5% glucose solution) until the start of the surgery. At the maintenance stage, infusion rate was decreased to 80% of normal maintenance fluid therapy. Normal maintenance fluid therapy was calculated according to the following empiric equations: for 0–10 kg = weight (kg) x 100 mL/kg/day, for 10–20 kg = 1000 mL + [weight (kg) x 50 mL/kg/day], and for >20 kg = 1500 mL + [weight (kg) x 20 mL/kg/day].^{9 (link)}All the patients were instructed to take nothing by mouth from admission until surgery.
During surgery, fluids were administered at the anesthetist’s discretion. All patients received intraoperative antibiotic prophylaxis. Anesthesia was induced with alfentanil, propofol, and suxamethonium and maintained with remifentanil and sevoflurane.