Liberal Versus Goal-directed Intraoperative Fluid Therapy in Pediatric Patients (GDT)

• Postoperative morbidity [ Time Frame: 4 days ] [ Designated as safety issue: Yes ]
  Postoperative morbidity: lung (new postoperative infiltration), prolonged ileus means inability to feed in postoperative day 4, kidney ( increase BUN, Cr), tissue hypoxia (wound infection, anastomotic leakage)
• Amount of intraoperative fluid [ Time Frame: 1 day ] [ Designated as safety issue: Yes ]
  Amount of intraoperative fluid

The objectives of this study are 1) to investigate the influence of different fluid regimen (Liberal regimen versus Goal directed therapy regimen) on postoperative outcome such as weight gain, delayed gut function recovery, pneumonia and 2) to ascertain the reliability of USCOM monitoring using serum lactate and base deficit as control parameters.

Liberal regimen = maintenance fluid(4/2/1) + deficit fluid + replacement of third space loss (>,=10ml/kg/h) Goal directed therapy regimen = maintenance fluid + deficit fluid + fluid replaced by hemodynamic monitoring guided.

• Drug: conventional liberal fluid regimen
  Control group will receive conventional liberal fluid regimen with crystalloid Liberal fluid regimen = Maintenance fluid + fasting fluid + dehydration + third space loss Maintenance fluid = (4X BW 1-10 kg) + (2X1BW11-20 kg) + (1X BW 0ver 21 kg) Fasting fluid = maintenance fluid X fasting duration
  Other Name: crystalloid
• Drug: restricted fluid regimen

  Study group will receive restricted fluid regimen (the same as control group except third space replacement) plus goal directed fluid therapy to maintain adequate CO guided by USCOM as shown in diagram (figure 1).

  Figure 1 goal directed fluid therapy SVV = Stroke volume variation SVI = Stroke volume index CI = Cardiac index

  Other Name: crystalloid

• Active Comparator: control group
  Control group will receive conventional liberal fluid regimen with crystalloid Liberal fluid regimen = Maintenance fluid + fasting fluid + dehydration + third space loss Maintenance fluid = (4X BW 1-10 kg) + (2X1BW11-20 kg) + (1X BW 0ver 21 kg) Fasting fluid = maintenance fluid X fasting duration
  Intervention: Drug: conventional liberal fluid regimen
• Experimental: study group

  Study group will receive restricted fluid regimen (the same as control group except third space replacement) plus goal directed fluid therapy to maintain adequate CO guided by USCOM as shown in diagram (figure 1).

  Figure 1 goal directed fluid therapy SVV = Stroke volume variation SVI = Stroke volume index CI = Cardiac index

  Intervention: Drug: restricted fluid regimen

Inclusion Criteria:

• Body weight < 15 kg
• Under going major abdominal surgery such as tumor removal, gut obstruction, pull through, etc. under general anesthesia and invasive arterial pressure monitoring if justified
• ASA < or = 3
• Duration of surgery > or = 2 hours

Exclusion Criteria:

• Cardiopulmonary disease
• Renal insufficiency
• Intraoperative complications such as massive bleeding, severe hypotension, prolonged need for mandatory ventilation
• reoperation