Babies - Acidosis Post Cranial Remodeling

[turnupthevapor]

Hello All

Question for you baby people (if you don't mind)

Please help me improve my technique....Once in a while I do the cranial remodeling cases. Usually a 10 kg kid (they do some endoscopic technique). Usually have 150 ml blood loss sometimes more (1/4 blood volume) . I have been using all .9 saline and blood when needed (25% cases)

At the end of the case i usually have a bicarb or 16 ish and a BD of -10ish. How can I avoid this? Should I replace the bicarb in these little dudes and dudets? If so how much? Should I be using half normal saline? Am I getting behind on fluids or are my fluids causing the problem? I usually have good urine output, bp, and heart rate.

any way you guys are pretty smart and I would like you to share your techniques with me

thank you very much

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[isoman2000]

A quick look leads me to believe that you are behind on your fluids and are experiencing lactic acidosis.

 

[Jeff05]

pH of NS is about 5.5.

try using plasmalyte instead.

 

[huktonfonix]

and your Cl- is? Of course your base deficit hints at likely fluid deficit.

 

[jetproppilot]

Hello All

Question for you baby people (if you don't mind)

Please help me improve my technique....Once in a while I do the cranial remodeling cases. Usually a 10 kg kid (they do some endoscopic technique). Usually have 150 ml blood loss sometimes more (1/4 blood volume) . I have been using all .9 saline and blood when needed (25% cases)

At the end of the case i usually have a bicarb or 16 ish and a BD of -10ish. How can I avoid this? Should I replace the bicarb in these little dudes and dudets? If so how much? Should I be using half normal saline? Am I getting behind on fluids or are my fluids causing the problem? I usually have good urine output, bp, and heart rate.

any way you guys are pretty smart and I would like you to share your techniques with me

thank you very much

Those are big, involved cases.....may I ask how the babies have done post op? Any complications? Or are they doing well in the ICU after the operation?

Reason I ask is because medicine, and the literature we tend to mould our practices by is fraught with SURROGATE ENDPOINTS.

Numbers that we've all chased in an effort to optimize the situation even though the number in question had no effect on outcome.

Our literature is littered with studies and studies touting "dangers" of drugs, techniques, et al because of numbers....

Many of these studies are meaningless since outcomes were not changed....i.e a good outcome occurred "despite" the bad number...

I'd say if the babies post operative outcomes have been visibly/objectively affected, you need to change something, like the above posters have suggested.

But if the babies have had healthy post-operative courses, then why chase numbers, considering you report hemodynamic stability and good urine output intraoperatively?

 

[aredoubleyou]

and your Cl- is? t.

Maybe hyperchloraemic acidosis secondary to relative large amout of NS.

But I wouldn't expect 1/2 NS to be a good solution since your trying to replace intravascular volume to some degree.

Try plasmalyte like Jeff said and see if this helps...let us know.

 

[militarymd]

jet's right

 

[Pooh & Annie]

Those are big, involved cases.....may I ask how the babies have done post op? Any complications? Or are they doing well in the ICU after the operation?

Reason I ask is because medicine, and the literature we tend to mould our practices by is fraught with SURROGATE ENDPOINTS.

Numbers that we've all chased in an effort to optimize the situation even though the number in question had no effect on outcome.

Our literature is littered with studies and studies touting "dangers" of drugs, techniques, et al because of numbers....

Many of these studies are meaningless since outcomes were not changed....i.e a good outcome occurred "despite" the bad number...

I'd say if the babies post operative outcomes have been visibly/objectively affected, you need to change something, like the above posters have suggested.

But if the babies have had healthy post-operative courses, then why chase numbers, considering you report hemodynamic stability and good urine output intraoperatively?

I don't know if the OP's problem has anything to do with incomplete literature. It sounds more like he/she is trying to avoid metabolic derangement at the end of these cases. If his patient's normally do well, than he probably shouldn't change anything. But who knows if a future patient might have a baseline metabolic issue and will benefit from an anesthetic that avoids further base deficit.

 

[turnupthevapor]

thank you for all the input....babies look good post op but I am just uneasy with an low ph in pacu.

QUESTION:

does the hyperchloremic metabolic acidosis from NS cause a Base Deficit? thanks again

 

[dfk]

thank you for all the input....babies look good post op but I am just uneasy with an low ph in pacu.

QUESTION:

does the hyperchloremic metabolic acidosis from NS cause a Base Deficit? thanks again

yes. chloride in, bicarb out.