P072: IMPACT OF RESTRICTIVE INTRAVENOUS FLUID STRATEGIES ON POSTOPERATIVE NAUSEA AND VOMITING IN PEDIATRIC TONSILLECTOMIES
Jaeyi Hahn1; Ajay Bharathan1; Benjamin Oakes1; Jason Liu1; Ajay Patel, MD2
1University of Central Florida College of Medicine; 2Nemours Children's Health
Introduction: Intravenous (IV) fluids are essential for perioperative care in pediatric patients, ensuring hemodynamic stability, electrolyte balance, and hydration. Adenotonsillectomy is associated with high rates of postoperative nausea and vomiting (PONV), where IV fluid management plays a critical role in optimizing perfusion and mitigating complications. Recent disruptions to IV fluid manufacturing following Hurricane Helene have exacerbated existing supply chain vulnerabilities, mirroring shortages experienced after Hurricane Maria in 2017. These crises emphasize the need for adaptive perioperative fluid management strategies, particularly the implications of restrictive IV fluid protocols in pediatric surgical populations.
Restrictive fluid strategies, commonly integrated into enhanced recovery after surgery (ERAS) protocols, aim to minimize complications such as edema and electrolyte imbalances while maintaining perfusion. Evidence from adult surgical populations suggests restrictive regimens may reduce perioperative weight gain but could increase risks of acute kidney injury and surgical-site infections. In pediatric patients, isotonic balanced crystalloids are preferred to mitigate risks of hyponatremia and metabolic disturbances. However, the impact of fluid restriction on PONV remains underexplored.
PONV affects up to 80% of pediatric patients undergoing high-risk procedures, with key risk factors including volatile anesthetics, nitrous oxide, and intraoperative opioids—factors potentially influenced by perioperative fluid strategies. While fluid restriction may exacerbate PONV by impairing tissue perfusion, excessive administration can contribute to hemodilution and edema, complicating recovery. Variability in perioperative fluid management underscores the need for standardized, evidence-based approaches tailored to pediatric patients.
Methods: This retrospective cohort study analyzes pediatric patients who underwent adenotonsillectomy at Nemours Children’s Hospital from June 24, 2024, to December 24, 2024 (three months before and after Hurricane Helene). Patients are stratified by intraoperative fluid management protocol: restricted fluid group (<10 mL/kg/h) and liberal fluid group (>10 mL/kg/h) Data is to be extracted from electronic medical records, including patient demographics, intraoperative fluid administration, postoperative nausea and vomiting (PONV) episodes, and other relevant perioperative details.
Statistical analysis will employ t-tests and chi-square tests to compare outcomes between groups pre- and post- restrictive fluid protocol. Key outcome measures include:
Length of stay (LOS), operation time, intraoperative and postoperative (PACU) opioid use, intraoperative and postoperative (PACU) non-narcotic analgesia (acetaminophen and NSAID) use, opioid prescriptions at discharge, Postoperative FLACC pain scores, PONV incidence, and readmissions within 30 days.
Results: Data collection is currently in progress. This study will analyze postoperative recovery data, including FLACC pain scores and PONV incidence to assess the impact of restrictive IV fluid protocols on pediatric surgical outcomes.
Discussion: Preliminary findings will inform evidence-based perioperative fluid management guidelines in the context of ongoing IV fluid shortages. By evaluating the balance between fluid restriction and patient safety, this study aims to optimize perioperative care and improve outcomes for pediatric patients undergoing tonsillectomy.