Perioperative fluid choice in pediatric anesthesia: a cross-sectional study of current practices in tertiary care hospitals of Karachi

Abstract

Background & objective: Every patient who undergoes some sort of surgery, whether under general, spinal, epidural or local anesthesia needs vascular access and fluid replacement. The choice of fluid is determined by many factors and may vary according to the center and the anesthetist. We evaluated perioperative fluid therapy practices among anesthetists managing pediatric surgical patients in tertiary care hospitals of Karachi (Pakistan) and assessed the influence of demographic and institutional factors on fluid selection.

Methodology: A cross-sectional study conducted between July 2021 - January 2022 in various tertiary care hospitals in Karachi, Pakistan. A total of 150 qualified FCPS and MCPS anesthetists were surveyed using a structured REDCap-based questionnaire. The SPSS version 26.0 was used to conduct the statistical analysis with the significance set at P < 0.05.

Results: Half strength dextrose saline (0.45 NaCl/5% glucose) was the most frequently used maintenance fluid in newborns (50.7%), whereas Ringer’s lactate (Hartmann's) was the most frequently used maintenance fluid in children >2 months (96.7-98%). Ringer’s Lactate (Hartmann's) was the preferred fluid for blood loss replacement across all age groups. The availability of a standardized fluid guidelines was reported by only 33.3% of anesthetists;  77.3% of them selected fluids according to the availability, instead of any protocol. Significant association between the fluid choice and variables such as gender (P = 0.039) and anesthetists’ qualification (P = 0.033), and years of experience (P = 0.040), as well as the institute type (P = 0.049) existed.

Conclusion: The nature of perioperative fluid practices for pediatric surgical patients between the anesthetists displays a significant difference depending on the pediatric age group and is affected by practitioner background and institutional setting. The persistent use of hypotonic fluids in neonates and poor guideline adherence highlight the urgent need for standardized protocols and targeted training in pediatric fluid management.

Keywords: Anesthetist practices; Cross-sectional study; Hypotonic solutions; Isotonic fluids; Guideline adherence; Pediatric anesthesia; Perioperative fluid therapy.

Citation: Kumar R, Najjad NAR, Batool M, Syed SA, Hiranand, Zahid MA. Perioperative fluid choice in pediatric anesthesia: a cross-sectional study of current practices in tertiary care hospitals of Karachi. Anaesth. pain intensive care 2026;30(2):240-247. DOI: 10.35975/apic.v30i2.3133

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2026