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Normovolemia (10Ns)

This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.

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Definition

Maintenance of expected circulating blood volume and body fluid homeostasis of the patient (age dependent).

Importance

Maintenance of physiological body fluid homeostasis is important for normal organ function. Deviations from this equilibrium (hypo- and hypervolemia) are commonly encountered in the peri-operative period.

Consequences

Hypovolemia

  • results in hypoperfusion and tissue hypoxia
  • hypovolemia is the leading cause of perioperative cardiac arrests (POCA) in children

Hypervolemia

  • dilutional coagulopathy
  • tissue edema

Prevention and treatment

  • preoperative clinical assessment (capillary refill time, urinary output) and correct preoperative disturbances if required
  • consider using other monitors which may include: invasive pressure monitoring, SvO2, repeated, periodical arterial blood gas analysis (acid base state) and non-invasive cardiac output monitors

Hypovolemia

  • avoid prolonged fasting times which can lead to hypovolemia
  • correct / minimize pre-operative deficits
  • sufficient IV access (size and number)
  • maintenance fluids
  • blood and coagulation management

Hypervolemia

  • close monitoring and control of fluid administration
  • correction of intraoperative coagulopathy

Key references

  1. Sümpelmann R, Becke K, Brenner S, Breschan C, Eich C, Höhne C, Jöhr M, Kretz FJ, Marx G, Pape L, Schreiber M, Strauss J, Weiss M. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. 2017 Jan;27(1):10-18. doi: 10.1111/pan.13007.

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